Provider Demographics
NPI:1568987923
Name:REBUCK, JASMINE ADAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ADAWN
Last Name:REBUCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 RIVINGTON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5588
Mailing Address - Country:US
Mailing Address - Phone:270-978-7317
Mailing Address - Fax:
Practice Address - Street 1:4304 S BEARFIELD RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-9557
Practice Address - Country:US
Practice Address - Phone:844-424-3577
Practice Address - Fax:573-634-3105
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical