Provider Demographics
NPI:1306400379
Name:BENSON, JASMINE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:BENSON
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 1:4255 EMILY LOOP APT 3C
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-0006
Mailing Address - Country:US
Mailing Address - Phone:704-493-5037
Mailing Address - Fax:
Practice Address - Street 1:4634 HARMONY LN
Practice Address - Street 2:
Practice Address - City:EFLAND
Practice Address - State:NC
Practice Address - Zip Code:27243-9456
Practice Address - Country:US
Practice Address - Phone:919-742-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician