Provider Demographics
NPI:1457013997
Name:LOUIS, JASMINE (LMSW)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:LOUIS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4671 CRESTED BUTTE RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9144
Mailing Address - Country:US
Mailing Address - Phone:803-466-5539
Mailing Address - Fax:
Practice Address - Street 1:1745 PHOENIX BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5534
Practice Address - Country:US
Practice Address - Phone:404-823-3514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14496181041S0200X
GAMSW009385104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool