Provider Demographics
NPI:1275878456
Name:JENKINS, JOSEPH SR (LSW/LICDC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:JENKINS
Suffix:SR
Gender:M
Credentials:LSW/LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 OFFICE PARK DR # D
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45439-2298
Mailing Address - Country:US
Mailing Address - Phone:937-802-5440
Mailing Address - Fax:
Practice Address - Street 1:3411 OFFICE PARK DR # D
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45439-2298
Practice Address - Country:US
Practice Address - Phone:937-802-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2025-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH162478101YA0400X
OHI.25067291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)