Provider Demographics
NPI:1780216671
Name:PAYNE, JASMINE NICOLE (MS)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:NICOLE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 PINETREE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2815
Mailing Address - Country:US
Mailing Address - Phone:804-337-4849
Mailing Address - Fax:
Practice Address - Street 1:4528 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-0141
Practice Address - Country:US
Practice Address - Phone:540-845-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health