Provider Demographics
NPI:1144470451
Name:JENKINS, EDWARD LEON JR
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:LEON
Last Name:JENKINS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EDWARD
Other - Middle Name:LEON
Other - Last Name:JENKINS
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:FAODP
Mailing Address - Street 1:15805 BAYLIS
Mailing Address - Street 2:204
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-1579
Mailing Address - Country:US
Mailing Address - Phone:313-728-1316
Mailing Address - Fax:313-341-1088
Practice Address - Street 1:15805 BAYLIS ST
Practice Address - Street 2:204
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3915
Practice Address - Country:US
Practice Address - Phone:313-728-1316
Practice Address - Fax:313-341-1088
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2025-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)