Basic Information
| Provider Information | |||||||||
| NPI: | 1639242423 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENKINS | ||||||||
| FirstName: | LORRAINE | ||||||||
| MiddleName: | K. | ||||||||
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| Credential: | CAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35572 POPLAR NECK RD | ||||||||
| Address2: | |||||||||
| City: | WILLARDS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218741340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108352977 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | WACS | ||||||||
| Address2: | 11827 OCEAN GATEWAY | ||||||||
| City: | OCEAN CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102130202 | ||||||||
| FaxNumber: | 4102131408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | ACO164 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.