Provider Demographics
NPI:1710402375
Name:HARRIS, JASMINE ALISHA (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:ALISHA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 PEBBLEBROOK TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-3970
Mailing Address - Country:US
Mailing Address - Phone:301-256-7939
Mailing Address - Fax:
Practice Address - Street 1:4545 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3045
Practice Address - Country:US
Practice Address - Phone:301-609-6736
Practice Address - Fax:301-609-6741
Is Sole Proprietor?:No
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD205991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical