Provider Demographics
NPI:1790250330
Name:MARTIN, JASMINE SHENICE
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:SHENICE
Last Name:MARTIN
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 1:131 BELMONT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4086
Mailing Address - Country:US
Mailing Address - Phone:919-602-8862
Mailing Address - Fax:
Practice Address - Street 1:920 BLAIRHILL RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-1565
Practice Address - Country:US
Practice Address - Phone:704-209-1021
Practice Address - Fax:980-203-2170
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician