Individual
EDDIE JENKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
856 TEXAS AVE, SHREVEPORT, LA 71101-3400
(318) 426-8096
(318) 227-6179
Mailing address
520 OLIVE ST, SHREVEPORT, LA 71104-2312
(318) 429-7500
(318) 227-6179
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
1594
LA
1041C0700X
Clinical Social Worker
Primary
1594
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417252230
—
LA
Enumeration date
04/08/2014
Last updated
09/25/2018
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