Provider Demographics
NPI:1841381787
Name:JENKINS-MONROE, VALATA (PHD)
Entity Type:Individual
Prefix:DR
First Name:VALATA
Middle Name:
Last Name:JENKINS-MONROE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 COLLEGE AVE
Mailing Address - Street 2:#230-B
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-2111
Mailing Address - Country:US
Mailing Address - Phone:510-547-7792
Mailing Address - Fax:510-547-7778
Practice Address - Street 1:5665 COLLEGE AVE
Practice Address - Street 2:#230-B
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-2111
Practice Address - Country:US
Practice Address - Phone:510-547-7792
Practice Address - Fax:510-547-7778
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9097103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical