Provider Demographics
NPI:1891443628
Name:KINCAID, JASMINE NICOLE (LPC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:NICOLE
Last Name:KINCAID
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6712 LISMORE DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-3434
Mailing Address - Country:US
Mailing Address - Phone:470-431-0414
Mailing Address - Fax:
Practice Address - Street 1:601 BOMBAY LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5828
Practice Address - Country:US
Practice Address - Phone:404-380-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-10
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC012779101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional