Provider Demographics
NPI:1205979630
Name:THE MARY JENKINS CENTER FOR BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:THE MARY JENKINS CENTER FOR BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-740-6999
Mailing Address - Street 1:3300 W MONTAGUE AVE
Mailing Address - Street 2:BLDG A SUITE 203
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-7916
Mailing Address - Country:US
Mailing Address - Phone:843-740-6999
Mailing Address - Fax:843-740-5433
Practice Address - Street 1:3300 W MONTAGUE AVE
Practice Address - Street 2:BLDG A SUITE 203
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-7916
Practice Address - Country:US
Practice Address - Phone:843-740-6999
Practice Address - Fax:843-740-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9864101YM0800X
2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1861499816OtherINDIVIDUAL NPI
SC1861499816OtherINDIVIDUAL NPI
SC7509Medicare PIN