Provider Demographics
NPI:1063165249
Name:JENKINS, LEKEILAH C (MSW, CWCM)
Entity type:Individual
Prefix:MISS
First Name:LEKEILAH
Middle Name:C
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MSW, CWCM
Other - Prefix:MISS
Other - First Name:LEKELIAH
Other - Middle Name:C
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, CWCM
Mailing Address - Street 1:8565 LAKE WINDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-7659
Mailing Address - Country:US
Mailing Address - Phone:850-800-7111
Mailing Address - Fax:
Practice Address - Street 1:2479 ALOMA AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2541
Practice Address - Country:US
Practice Address - Phone:407-657-6692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health