Provider Demographics
NPI:1780327700
Name:WILLIAMS, JASMINE RENEE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:RENEE
Last Name:WILLIAMS
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 1:5055 HARBOUR LAKE DR APT 2F
Mailing Address - Street 2:
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-5907
Mailing Address - Country:US
Mailing Address - Phone:843-367-4753
Mailing Address - Fax:
Practice Address - Street 1:5055 HARBOUR LAKE DR APT 2F
Practice Address - Street 2:
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-5907
Practice Address - Country:US
Practice Address - Phone:843-367-4753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician