Provider Demographics
NPI:1659637007
Name:JENKINS, KIM YVONNE (MSW,P-LCSW)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:YVONNE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MSW,P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MORRIS RD
Mailing Address - Street 2:
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-9783
Mailing Address - Country:US
Mailing Address - Phone:252-287-9948
Mailing Address - Fax:
Practice Address - Street 1:234 MAIN ST E
Practice Address - Street 2:
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-3418
Practice Address - Country:US
Practice Address - Phone:252-862-0002
Practice Address - Fax:252-862-0007
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0068041041C0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical