Provider Demographics
NPI:1811312242
Name:JENKINS, LISA ALEXANDER (LCSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ALEXANDER
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-5577
Mailing Address - Country:US
Mailing Address - Phone:304-616-1545
Mailing Address - Fax:703-771-2990
Practice Address - Street 1:44075 PIPELINE PLZ
Practice Address - Street 2:STE 220
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5890
Practice Address - Country:US
Practice Address - Phone:304-616-1545
Practice Address - Fax:703-771-2990
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040074381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical