Provider Demographics
NPI:1386398766
Name:JENKINS, LA SHONA SHERI (DSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:LA SHONA
Middle Name:SHERI
Last Name:JENKINS
Suffix:
Gender:F
Credentials:DSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 W REDONDO BEACH BLVD UNIT 2585
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-6535
Mailing Address - Country:US
Mailing Address - Phone:310-308-4539
Mailing Address - Fax:
Practice Address - Street 1:12830 COLUMBIA WAY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-4720
Practice Address - Country:US
Practice Address - Phone:310-308-4539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA656821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical