Provider Demographics
NPI:1720083371
Name:JENKINS, TAMARA (MSSW)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750-C WOODMERE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-244-7322
Mailing Address - Fax:334-356-1603
Practice Address - Street 1:4750-C WOODMERE BLVD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-244-7322
Practice Address - Fax:334-356-1603
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-19
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0727C-130P1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL339051068Medicaid
AL339051068Medicaid
AL631105717OtherEIN
AL339051068Medicaid
AL043235Medicare ID - Type Unspecified