Provider Demographics
NPI:1285388074
Name:GRANT, JASMINE (LAPC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:GRANT
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MARY ERNA DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-2720
Mailing Address - Country:US
Mailing Address - Phone:404-867-3418
Mailing Address - Fax:
Practice Address - Street 1:400 MARY ERNA DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-2720
Practice Address - Country:US
Practice Address - Phone:404-867-3418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC006912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health