Provider Demographics
NPI:1225345572
Name:JENKINS, CHRISTINA NICOLE (LCSW81243)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:NICOLE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCSW81243
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 HIGH MESA DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2692
Mailing Address - Country:US
Mailing Address - Phone:415-307-4695
Mailing Address - Fax:
Practice Address - Street 1:109 HIGH MESA DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2692
Practice Address - Country:US
Practice Address - Phone:415-307-4695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CALCSW812431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA81243OtherLCSW