Provider Demographics
NPI:1417670571
Name:JEFFERSON, JASMINE ANGELIC (LCSWA)
Entity Type:Individual
Prefix:MRS
First Name:JASMINE
Middle Name:ANGELIC
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 FREEDOM DR STE 2
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-4035
Mailing Address - Country:US
Mailing Address - Phone:704-537-7775
Mailing Address - Fax:
Practice Address - Street 1:2225 FREEDOM DR STE 2
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28208-4035
Practice Address - Country:US
Practice Address - Phone:704-537-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0180181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical