Provider Demographics
NPI:1336861293
Name:LARKINS, JESSIE (LCMHCA)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:LARKINS
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 GLENDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4115
Mailing Address - Country:US
Mailing Address - Phone:919-624-5398
Mailing Address - Fax:
Practice Address - Street 1:2611 GLENDALE AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-4115
Practice Address - Country:US
Practice Address - Phone:919-624-5398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18061101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health