Provider Demographics
NPI:1649813668
Name:JENKINS, DEBRA ANN (LCMHCA, LCAS, CPSS)
Entity type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:ANN
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCMHCA, LCAS, CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7315 CIRCLEBANK DRIVE
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-5611
Mailing Address - Country:US
Mailing Address - Phone:347-272-9041
Mailing Address - Fax:
Practice Address - Street 1:7315 CIRCLEBANK DRIVE
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-5611
Practice Address - Country:US
Practice Address - Phone:347-272-9041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-22
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-25944101YA0400X
NCA14979101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)