Provider Demographics
NPI:1013677806
Name:JENKINS, MARIE RUTH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:RUTH
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:RUTH
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:601 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:CROSSETT
Mailing Address - State:AR
Mailing Address - Zip Code:71635-3517
Mailing Address - Country:US
Mailing Address - Phone:601-307-4775
Mailing Address - Fax:
Practice Address - Street 1:614 N MARTIN ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:AR
Practice Address - Zip Code:71671-1904
Practice Address - Country:US
Practice Address - Phone:870-466-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6022-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical