Provider Demographics
NPI:1790546943
Name:BACKMON, JASMINE CHARLENE (LMSW)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:CHARLENE
Last Name:BACKMON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 BUSINESS PARK BLVD APT 631
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-8913
Mailing Address - Country:US
Mailing Address - Phone:803-394-0292
Mailing Address - Fax:
Practice Address - Street 1:261 BUSINESS PARK BLVD APT 631
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8913
Practice Address - Country:US
Practice Address - Phone:803-394-0292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15352104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker