Provider Demographics
NPI:1013283969
Name:JENKIN, BARBARA (MA,CAP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:JENKIN
Suffix:
Gender:F
Credentials:MA,CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 SOUTHPARK CIRCLE EAST
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086
Mailing Address - Country:US
Mailing Address - Phone:410-703-4133
Mailing Address - Fax:904-797-5681
Practice Address - Street 1:248 SOUTHPARK CIR E
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5137
Practice Address - Country:US
Practice Address - Phone:410-703-4133
Practice Address - Fax:904-797-5681
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0755AD374301101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)