Provider Demographics
NPI:1053675785
Name:IRVIN, JASMINE TI (PHD)
Entity Type:Individual
Prefix:DR
First Name:JASMINE
Middle Name:TI
Last Name:IRVIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W LAVENDER AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-4251
Mailing Address - Country:US
Mailing Address - Phone:919-302-2308
Mailing Address - Fax:
Practice Address - Street 1:210 W LAVENDER AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-4251
Practice Address - Country:US
Practice Address - Phone:919-302-2308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4548103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical