Provider Demographics
NPI:1104830819
Name:JENKINS, JOHNNIE LEE III (MA, NCC, RPT, LPC)
Entity type:Individual
Prefix:MR
First Name:JOHNNIE
Middle Name:LEE
Last Name:JENKINS
Suffix:III
Gender:M
Credentials:MA, NCC, RPT, LPC
Other - Prefix:
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Mailing Address - Street 1:PO BOX 490657
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-0657
Mailing Address - Country:US
Mailing Address - Phone:770-309-5468
Mailing Address - Fax:678-907-5468
Practice Address - Street 1:2531 BRIARCLIFF RD NE STE 102
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-3017
Practice Address - Country:US
Practice Address - Phone:770-309-5468
Practice Address - Fax:678-907-5468
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA3039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional