Provider Demographics
NPI:1215227640
Name:EATMAN, JASMINE N (LCAS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:N
Last Name:EATMAN
Suffix:
Gender:F
Credentials:LCAS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-4346
Mailing Address - Country:US
Mailing Address - Phone:980-581-3092
Mailing Address - Fax:
Practice Address - Street 1:431 RIDGE ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-4346
Practice Address - Country:US
Practice Address - Phone:704-550-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2626101YA0400X
NC8673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional