Provider Demographics
NPI:1073174769
Name:SIMMONS, JASMINE ARIANA (MS, LCAS-A)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:ARIANA
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MS, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 TILGHMAN RD N
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-8940
Mailing Address - Country:US
Mailing Address - Phone:919-928-6099
Mailing Address - Fax:
Practice Address - Street 1:3208 SUNSET AVE STE B
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3590
Practice Address - Country:US
Practice Address - Phone:252-212-5524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor