Provider Demographics
NPI:1548145592
Name:JENKINS, DAVID (LAPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:JENKINS
Suffix:
Gender:M
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 PRIOR ST NE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3441
Mailing Address - Country:US
Mailing Address - Phone:678-971-5355
Mailing Address - Fax:
Practice Address - Street 1:5505 CHURCH ST
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-5781
Practice Address - Country:US
Practice Address - Phone:678-828-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC010389101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health