Provider Demographics
NPI:1871783498
Name:JENKINS, SUSAN CAROL (PHD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:CAROL
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4424 MONTGOMERY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4409
Mailing Address - Country:US
Mailing Address - Phone:301-951-1990
Mailing Address - Fax:310-951-1998
Practice Address - Street 1:4424 MONTGOMERY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4409
Practice Address - Country:US
Practice Address - Phone:301-951-1990
Practice Address - Fax:310-951-1998
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02196103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical