Provider Demographics
NPI:1023550464
Name:JARAMILLO-MORA, JASMELLE
Entity Type:Individual
Prefix:
First Name:JASMELLE
Middle Name:
Last Name:JARAMILLO-MORA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 HAILEYS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LILESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28091-7099
Mailing Address - Country:US
Mailing Address - Phone:786-393-3941
Mailing Address - Fax:
Practice Address - Street 1:1018 N BRAGG BLVD
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-3316
Practice Address - Country:US
Practice Address - Phone:910-295-2609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-16
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT1745161106S00000X
NCRBT1745161106S00000X
NC02111848106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician