Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | ||
N | 225XM0800X | Mental Health |
NPI | 1881369338 |
---|---|
Provider Name | Dominick Jenkins |
First Address | Towson, MD 21204-0868 |
Second Address | Towson, MD 21204-0868 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2021 |
Last Update Date | 19/11/2021 |