Provider Demographics
NPI:1760967699
Name:DOXIE, JASMINE (EDS, NCC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:DOXIE
Suffix:
Gender:F
Credentials:EDS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 BRIERCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-9532
Mailing Address - Country:US
Mailing Address - Phone:803-420-3743
Mailing Address - Fax:
Practice Address - Street 1:304 BRIERCLIFF DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-9532
Practice Address - Country:US
Practice Address - Phone:803-420-3743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-26
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC7963101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health