Provider Demographics
NPI:1720779937
Name:JAZMIN, STEPHANIE ANNETTE (MSW, LCSWA)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:ANNETTE
Last Name:JAZMIN
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3012 APPLE ORCHARD PL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-9583
Mailing Address - Country:US
Mailing Address - Phone:347-723-0529
Mailing Address - Fax:
Practice Address - Street 1:3012 APPLE ORCHARD PL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:NC
Practice Address - Zip Code:28034-9583
Practice Address - Country:US
Practice Address - Phone:347-723-0529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12269181041S0200X
NCP0189591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool