Provider Demographics
NPI:1184748618
Name:JENKINS, THOMASINA MARIE (LCSW,CSAC)
Entity type:Individual
Prefix:MISS
First Name:THOMASINA
Middle Name:MARIE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCSW,CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:8018 W CAPITOL DR STE 103
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-1906
Mailing Address - Country:US
Mailing Address - Phone:414-369-2856
Mailing Address - Fax:414-369-3944
Practice Address - Street 1:3522 W LISBON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1953
Practice Address - Country:US
Practice Address - Phone:414-935-8000
Practice Address - Fax:414-344-3396
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2019-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15353-132101YA0400X
WI7605-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43715900Medicaid