Provider Demographics
NPI:1417463290
Name:JOHNSON, JASMINE N (MA ,LCMHC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA ,LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-7943
Mailing Address - Country:US
Mailing Address - Phone:919-771-5691
Mailing Address - Fax:
Practice Address - Street 1:392 SUMMERWIND PLANTATION DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-6044
Practice Address - Country:US
Practice Address - Phone:919-771-5691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health