Provider Demographics
NPI:1366778896
Name:JENKINS, EVELYN (LCSW)
Entity type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:
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 1:141 COVE VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:GRAMBLING
Mailing Address - State:LA
Mailing Address - Zip Code:71245-2403
Mailing Address - Country:US
Mailing Address - Phone:318-737-7374
Mailing Address - Fax:
Practice Address - Street 1:141 COVE VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:GRAMBLING
Practice Address - State:LA
Practice Address - Zip Code:71245-2403
Practice Address - Country:US
Practice Address - Phone:318-737-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-17
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA33981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical