Provider Demographics
NPI:1548536600
Name:JENKINS, VERNELL (SOCIAL WORK)
Entity type:Individual
Prefix:
First Name:VERNELL
Middle Name:
Last Name:JENKINS
Suffix:
Gender:F
Credentials:SOCIAL WORK
Other - Prefix:
Other - First Name:VERNELL
Other - Middle Name:
Other - Last Name:JENKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SOCIAL WORK
Mailing Address - Street 1:PO BOX 246354
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95824-6354
Mailing Address - Country:US
Mailing Address - Phone:916-826-5920
Mailing Address - Fax:
Practice Address - Street 1:10284 SHOECH WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-3529
Practice Address - Country:US
Practice Address - Phone:916-826-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical