Provider Demographics
NPI:1154925857
Name:JACKSON, JASMINE M (ALC)
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:M
Last Name:JACKSON
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6251 RIME VILLAGE DR APT 207
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35806
Mailing Address - Country:US
Mailing Address - Phone:314-303-5940
Mailing Address - Fax:256-999-0729
Practice Address - Street 1:SCOTTSBORO PROFESSIONAL COUNSELING
Practice Address - Street 2:605 E LAUREL ST
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768
Practice Address - Country:US
Practice Address - Phone:256-999-0727
Practice Address - Fax:256-999-0729
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor