Provider Demographics
NPI:1700944048
Name:JENKINS, SHERETA (MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:SHERETA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28359-0513
Mailing Address - Country:US
Mailing Address - Phone:910-739-5518
Mailing Address - Fax:910-739-5520
Practice Address - Street 1:213 E 3RD ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-5627
Practice Address - Country:US
Practice Address - Phone:910-739-5518
Practice Address - Fax:910-739-5520
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0053771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106443Medicaid