Provider Demographics
NPI:1740036417
Name:THOMPSON, JAZMINE JAMEA
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:JAMEA
Last Name:THOMPSON
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 1:7713 STEELE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-6937
Mailing Address - Country:US
Mailing Address - Phone:334-349-0120
Mailing Address - Fax:
Practice Address - Street 1:4171 LOMAC ST STE F
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2945
Practice Address - Country:US
Practice Address - Phone:334-267-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional