Provider Demographics
NPI:1104505064
Name:GANT, JASMINE DANISHA
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:DANISHA
Last Name:GANT
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 1:4018 COBBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DISPUTANTA
Mailing Address - State:VA
Mailing Address - Zip Code:23842-4516
Mailing Address - Country:US
Mailing Address - Phone:804-895-4573
Mailing Address - Fax:
Practice Address - Street 1:4018 COBBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:DISPUTANTA
Practice Address - State:VA
Practice Address - Zip Code:23842-4516
Practice Address - Country:US
Practice Address - Phone:804-895-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0732009964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health