Basic Information
| Provider Information | |||||||||
| NPI: | 1366534182 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JENKINS-DAVIS | ||||||||
| FirstName: | KEONTE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1807A E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296403841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644427482 | ||||||||
| FaxNumber: | 8643077977 | ||||||||
| Practice Location | |||||||||
| Address1: | 1807A E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | EASLEY | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296403841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8644427482 | ||||||||
| FaxNumber: | 8643077977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6077 | SC | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.