Provider Demographics
NPI:1598083792
Name:JENKS, CONNIE LYNN (LPC)
Entity type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:LYNN
Last Name:JENKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:384 GAN WAY
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-9403
Mailing Address - Country:US
Mailing Address - Phone:804-683-2923
Mailing Address - Fax:
Practice Address - Street 1:6565 ARLINGTON BLVD STE 405
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3000
Practice Address - Country:US
Practice Address - Phone:703-596-4796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-12
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
VA1041C0700X
VA0701004851101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical