Provider Demographics
NPI:1841711314
Name:POPE, JASMINE LYNN (LISW, LICDC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:LYNN
Last Name:POPE
Suffix:
Gender:F
Credentials:LISW, LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 FAIRFAX RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-5211
Mailing Address - Country:US
Mailing Address - Phone:419-239-4079
Mailing Address - Fax:
Practice Address - Street 1:4334 W CENTRAL AVE STE 203
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1679
Practice Address - Country:US
Practice Address - Phone:419-239-4079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-05
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161675101YA0400X
OHI.18013001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)