Provider Demographics
NPI:1689116543
Name:JENKINS, DOUGLAS TRUE I (CASAC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:TRUE
Last Name:JENKINS
Suffix:I
Gender:M
Credentials:CASAC
Other - Prefix:MR
Other - First Name:DOUGLAS
Other - Middle Name:TRUE
Other - Last Name:JENKINS
Other - Suffix:I
Other - Last Name Type:Former Name
Other - Credentials:CASAC
Mailing Address - Street 1:5714 FARRAGUT RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-1346
Mailing Address - Country:US
Mailing Address - Phone:718-840-9982
Mailing Address - Fax:
Practice Address - Street 1:5714 FARRAGUT RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-1346
Practice Address - Country:US
Practice Address - Phone:718-840-9982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY26846101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)