Provider Demographics
NPI:1225770290
Name:THOMPSON, JASMINE OMEGA
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:OMEGA
Last Name:THOMPSON
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 1:3412 SPENDTHRIFT DR APT 609
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-5306
Mailing Address - Country:US
Mailing Address - Phone:804-873-6769
Mailing Address - Fax:
Practice Address - Street 1:3412 SPENDTHRIFT DR APT 609
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23294-5306
Practice Address - Country:US
Practice Address - Phone:804-873-6769
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0734006399101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health