Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 009136 | CT |
N | 101YP1600X | Pastoral Counselor | 009136 | CT |
N | 101YP2500X | Professional Counselor | 009136 | CT |
NPI | 1164877312 |
---|---|
Provider Name | Mrs. Patricia Marie Jenkins-Simmons |
First Address | New Haven, CT 06511-4939 |
Second Address | New Haven, CT 06511-4939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2016 |
Last Update Date | 25/04/2016 |