Provider Demographics
NPI:1720808587
Name:JENKINS, WANITA CECILIA LEVIA (LPC)
Entity type:Individual
Prefix:MS
First Name:WANITA
Middle Name:CECILIA LEVIA
Last Name:JENKINS
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 1:5714 W OXFORD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-3431
Mailing Address - Country:US
Mailing Address - Phone:215-917-5336
Mailing Address - Fax:
Practice Address - Street 1:7900 OLD YORK RD STE 114A
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-2324
Practice Address - Country:US
Practice Address - Phone:267-259-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional