Provider Demographics
NPI:1487040572
Name:YOUNG-BRADSHAW, JASMIN (LMFT)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:YOUNG-BRADSHAW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5217 HOLLY RIDGE FARM RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-8060
Mailing Address - Country:US
Mailing Address - Phone:562-522-7662
Mailing Address - Fax:
Practice Address - Street 1:804 SALEM WOODS DR STE 202
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-3343
Practice Address - Country:US
Practice Address - Phone:919-759-6756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2018-068106H00000X
NC00666106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist