Provider Demographics
NPI:1023308079
Name:JENKINS, JENNICA RACHEL (PSYD, LPC, LPCC, PPS)
Entity type:Individual
Prefix:DR
First Name:JENNICA
Middle Name:RACHEL
Last Name:JENKINS
Suffix:
Gender:F
Credentials:PSYD, LPC, LPCC, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 SUNSET BLVD # 170-241
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-4338
Mailing Address - Country:US
Mailing Address - Phone:916-747-3799
Mailing Address - Fax:
Practice Address - Street 1:1899 E ROSEVILLE PKWY STE 140
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-7980
Practice Address - Country:US
Practice Address - Phone:916-747-3799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-12
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC6072101YP2500X
CA50164430101YS0200X
CA26101YP2500X
EXAM PASS # 275107101YM0800X
PSYD CCU SANTA ANA101YA0400X
TRAUMA AND LOSS CERT146D00000X
ADOLESCENT1744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No1744R1102XOther Service ProvidersSpecialistResearch Study
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA26OtherCA BOARD OF BEHAVIORAL SCIENCES