Provider Demographics
NPI:1457133472
Name:DRAKE, JASMINE (LPC)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:DRAKE
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 1:1 WALCOTT CIR
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7847
Mailing Address - Country:US
Mailing Address - Phone:843-263-0201
Mailing Address - Fax:
Practice Address - Street 1:5618 WHITE BLUFF RD STE B
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5520
Practice Address - Country:US
Practice Address - Phone:912-319-4693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012851101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional