Provider Demographics
NPI:1245041102
Name:BURNS, JASMINE DEAUNDRA
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:DEAUNDRA
Last Name:BURNS
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 1:407 THOROUGHBRED DR
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-6891
Mailing Address - Country:US
Mailing Address - Phone:843-312-4725
Mailing Address - Fax:
Practice Address - Street 1:3255 LANDMARK DR STE 206
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418-8573
Practice Address - Country:US
Practice Address - Phone:843-964-8007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10222101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health