Provider Demographics
NPI:1932677556
Name:BURTON, JASMINE (LCPC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:BURTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10005 OLD COLUMBIA RD STE L260
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1722
Mailing Address - Country:US
Mailing Address - Phone:443-259-0400
Mailing Address - Fax:443-259-0044
Practice Address - Street 1:10005 OLD COLUMBIA RD STE L260
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1722
Practice Address - Country:US
Practice Address - Phone:443-259-0400
Practice Address - Fax:443-259-0044
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9071101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional