Provider Demographics
NPI:1285979963
Name:JENKINS, KIMBERLY COCHRAN
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:COCHRAN
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 1:6220 THERMAL RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-5630
Mailing Address - Country:US
Mailing Address - Phone:704-366-8712
Mailing Address - Fax:704-362-8464
Practice Address - Street 1:1201 S POST RD STE 2
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28152-7417
Practice Address - Country:US
Practice Address - Phone:704-366-8712
Practice Address - Fax:704-362-8464
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional