Individual
ANDREA JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4024 ASHBOURNE LN, INDIANAPOLIS, IN 46226-3019
(317) 796-2622
Mailing address
4024 ASHBOURNE LN, INDIANAPOLIS, IN 46226-3019
(317) 281-8466
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
33005529A
IN
1041C0700X
Clinical Social Worker
Primary
34006421A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100270530A
—
IN
Enumeration date
10/09/2009
Last updated
03/01/2022
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