Provider Demographics
NPI:1265536965
Name:JENKINS, TERESA MARTIN (LCSW)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARTIN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:RENEE
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1320 CENTRAL PK BLVD STE 229
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401
Mailing Address - Country:US
Mailing Address - Phone:540-548-4842
Mailing Address - Fax:540-548-4824
Practice Address - Street 1:1320 CENTRAL PK BLVD STE 229
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-548-4842
Practice Address - Fax:540-548-4824
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0094 0027161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA220417OtherANTHEM
VA115680OtherVALUE OPTIONS
227773OtherTRICARE
329731OtherMAMS
329731OtherALLIANCE
5925667OtherAETNA
0814OtherCAREFIRST
329731OtherOCI