Provider Demographics
NPI:1629543962
Name:COLEGROVE, JASMINE C (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:C
Last Name:COLEGROVE
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:C
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSWA
Mailing Address - Street 1:4075 CREEKSTONE TRCE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-4312
Mailing Address - Country:US
Mailing Address - Phone:704-981-1170
Mailing Address - Fax:
Practice Address - Street 1:4075 CREEKSTONE TRCE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-4312
Practice Address - Country:US
Practice Address - Phone:704-981-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0133011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical