Provider Demographics
NPI:1003611674
Name:MOORE, JASMINE EILEEN (LCSWA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:EILEEN
Last Name:MOORE
Suffix:
Gender:
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MERRIMON AVE # 1179
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-2322
Mailing Address - Country:US
Mailing Address - Phone:828-500-1620
Mailing Address - Fax:
Practice Address - Street 1:65 MERRIMON AVE # 1179
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2322
Practice Address - Country:US
Practice Address - Phone:828-500-1620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health