Provider Demographics
NPI:1538798327
Name:JENKINS, WILLIE PATRICE (LCSW)
Entity type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:PATRICE
Last Name:JENKINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:DR
Other - First Name:PATRICE
Other - Middle Name:
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 59440
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39284-9440
Mailing Address - Country:US
Mailing Address - Phone:601-502-0493
Mailing Address - Fax:
Practice Address - Street 1:108 PARKS RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-9626
Practice Address - Country:US
Practice Address - Phone:601-260-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC71541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical