Provider Demographics
NPI:1013635481
Name:JENKINS, JESSICA (CSW008049)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:CSW008049
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 HERRINGTON RD APT 3107
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6425
Mailing Address - Country:US
Mailing Address - Phone:678-670-7379
Mailing Address - Fax:
Practice Address - Street 1:1335 HERRINGTON RD APT 3107
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6425
Practice Address - Country:US
Practice Address - Phone:404-907-1294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0080491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical