Provider Demographics
NPI:1407433840
Name:IVERSON, JASMINE S (LCSW)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:S
Last Name:IVERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 NEWFOUND HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-4502
Mailing Address - Country:US
Mailing Address - Phone:336-317-3529
Mailing Address - Fax:
Practice Address - Street 1:301 S MCDOWELL ST STE 125-1325
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2623
Practice Address - Country:US
Practice Address - Phone:336-317-3529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0156741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical