Provider Demographics
NPI:1427110303
Name:JENKINS, CARROLL GARDNER (LCSW, LAC, SAP)
Entity type:Individual
Prefix:MR
First Name:CARROLL
Middle Name:GARDNER
Last Name:JENKINS
Suffix:
Gender:M
Credentials:LCSW, LAC, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 N BENTON AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-2752
Mailing Address - Country:US
Mailing Address - Phone:406-442-3045
Mailing Address - Fax:406-442-3144
Practice Address - Street 1:1002 N BENTON AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-2752
Practice Address - Country:US
Practice Address - Phone:406-442-3045
Practice Address - Fax:406-442-3144
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT672101YA0400X
MT591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0500240Medicaid
MT70070OtherPROVIDER NUMBER BC BS
MT0500240Medicaid