Provider Demographics
NPI:1568115871
Name:JENKINS, CATHERINE COOPER (MA, BCBA)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:COOPER
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:LEE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:104 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-2811
Mailing Address - Country:US
Mailing Address - Phone:540-280-5452
Mailing Address - Fax:
Practice Address - Street 1:5949 HARBOUR PARK DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2163
Practice Address - Country:US
Practice Address - Phone:804-352-6456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-21-169780106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
VARBT-21-169780OtherBCBA
1-23-64242OtherBACB