Provider Demographics
NPI:1831773324
Name:ELROD, JASMINE OPAL (LISW-CP)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:OPAL
Last Name:ELROD
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 LOCKHURST DR
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-3945
Mailing Address - Country:US
Mailing Address - Phone:864-884-2506
Mailing Address - Fax:
Practice Address - Street 1:812 LOCKHURST DR
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3945
Practice Address - Country:US
Practice Address - Phone:864-884-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-10
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC112961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical