Provider Demographics
NPI:1447845821
Name:THE JENKINS CREATIVE COUNSELING CENTER, PLLC
Entity type:Organization
Organization Name:THE JENKINS CREATIVE COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OUTPATIENT THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANIECE
Authorized Official - Middle Name:BRIANNE PETERSON
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:980-275-9119
Mailing Address - Street 1:6849 FAIRVIEW RD STE 702
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3393
Mailing Address - Country:US
Mailing Address - Phone:980-308-4500
Mailing Address - Fax:980-458-6037
Practice Address - Street 1:6849 FAIRVIEW RD STE 702
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3393
Practice Address - Country:US
Practice Address - Phone:980-308-4500
Practice Address - Fax:980-458-6037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-07
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty