Provider Demographics
NPI:1811758972
Name:GRUBBS, JASMINE S
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:S
Last Name:GRUBBS
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 1:2699 COUNTY ROAD 46
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36310-6364
Mailing Address - Country:US
Mailing Address - Phone:334-798-2393
Mailing Address - Fax:
Practice Address - Street 1:2699 COUNTY ROAD 46
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:AL
Practice Address - Zip Code:36310-6364
Practice Address - Country:US
Practice Address - Phone:334-798-2393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALBACB961800106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician