Provider Demographics
NPI:1457816738
Name:GRIFFIN, JASMINE SHANTA
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:SHANTA
Last Name:GRIFFIN
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 1:7931 AVERETTE HILL DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5560
Mailing Address - Country:US
Mailing Address - Phone:919-696-3059
Mailing Address - Fax:
Practice Address - Street 1:VISION BEHAVIORAL HEALTH SERVICEA
Practice Address - Street 2:104 NORTH MAIN ST. SUITE 200
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549
Practice Address - Country:US
Practice Address - Phone:919-496-7781
Practice Address - Fax:919-496-1477
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical