Provider Demographics
NPI:1386086684
Name:JENKINS, BONITA B (MSW, LCSWA)
Entity type:Individual
Prefix:MS
First Name:BONITA
Middle Name:B
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:MS
Other - First Name:BONITA
Other - Middle Name:B
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSWA
Mailing Address - Street 1:369 HWY 13 S
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-8472
Mailing Address - Country:US
Mailing Address - Phone:252-747-5705
Mailing Address - Fax:252-747-5635
Practice Address - Street 1:369 HWY 13 S
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-8472
Practice Address - Country:US
Practice Address - Phone:252-747-5705
Practice Address - Fax:252-747-5635
Is Sole Proprietor?:No
Enumeration Date:2013-07-27
Last Update Date:2013-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0082251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical