Provider Demographics
NPI:1336375245
Name:JENKINS-KENDRICK, NELLIE LAVERN (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:NELLIE
Middle Name:LAVERN
Last Name:JENKINS-KENDRICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:16844 PRINCETON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48221-3157
Mailing Address - Country:US
Mailing Address - Phone:313-397-3216
Mailing Address - Fax:313-397-3216
Practice Address - Street 1:16838 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1519
Practice Address - Country:US
Practice Address - Phone:313-245-0870
Practice Address - Fax:313-245-0575
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010797061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical