Provider Demographics
NPI:1770019432
Name:MCKOY, JASMINE VICTORIA
Entity Type:Individual
Prefix:MISS
First Name:JASMINE
Middle Name:VICTORIA
Last Name:MCKOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ASHLYN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-3362
Mailing Address - Country:US
Mailing Address - Phone:919-609-6421
Mailing Address - Fax:
Practice Address - Street 1:120 ASHLYN RIDGE DR
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3362
Practice Address - Country:US
Practice Address - Phone:919-609-6421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCRBT-16-27572106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician