Provider Demographics
NPI:1134374747
Name:JENKINS, CRISTAL ROSE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:CRISTAL
Middle Name:ROSE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:CRISTAL
Other - Middle Name:ROSE
Other - Last Name:GERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:4318 OLD HUNDRED RD STE C
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-4231
Mailing Address - Country:US
Mailing Address - Phone:804-621-5572
Mailing Address - Fax:253-620-5831
Practice Address - Street 1:4318 OLD HUNDRED RD STE C
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-4231
Practice Address - Country:US
Practice Address - Phone:804-621-5572
Practice Address - Fax:253-620-5831
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60063009101YM0800X
VA09040111501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health