Provider Demographics
NPI:1245030253
Name:JENKINS, JUDITH BROWN
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:BROWN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 SOUNDINGS CRESCENT CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3734
Mailing Address - Country:US
Mailing Address - Phone:757-390-8674
Mailing Address - Fax:
Practice Address - Street 1:2021 SOUNDINGS CRESCENT CT
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3734
Practice Address - Country:US
Practice Address - Phone:757-390-8674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0730000686101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health