Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | PSYD CCU SANTA ANA | |
N | 101YM0800X | Mental Health Counselor | EXAM PASS # 275107 | |
Y | 101YP2500X | Professional Counselor | 26 | CA |
N | 101YP2500X | Professional Counselor | LPC6072 | CO |
N | 101YS0200X | School Counselor | 50164430 | CA |
NPI | 1023308079 |
---|---|
Provider Name | Dr. Jennica Rachel Jenkins |
First Address | Rocklin, CA 95765-4338 |
Second Address | Roseville, CA 95661-7980 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2011 |
Last Update Date | 08/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
26 | CA BOARD OF BEHAVIORAL SCIENCES (01) | CA |