Provider Demographics
NPI:1952630154
Name:JENKINS, NAOMI S
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:S
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:CUTHBERT
Mailing Address - State:GA
Mailing Address - Zip Code:39840-0481
Mailing Address - Country:US
Mailing Address - Phone:229-732-2437
Mailing Address - Fax:
Practice Address - Street 1:264 LUMPKIN STREET
Practice Address - Street 2:
Practice Address - City:CUTHBERT
Practice Address - State:GA
Practice Address - Zip Code:39840
Practice Address - Country:US
Practice Address - Phone:229-732-2437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor