Provider Demographics
NPI:1487438461
Name:CUPIN-DAVENPORT, JASMINE ERIKA REAL (MS, NCC)
Entity type:Individual
Prefix:
First Name:JASMINE ERIKA
Middle Name:REAL
Last Name:CUPIN-DAVENPORT
Suffix:
Gender:F
Credentials:MS, NCC
Other - Prefix:
Other - First Name:JASMINE ERIKA
Other - Middle Name:REAL
Other - Last Name:CUPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, NCC
Mailing Address - Street 1:13817 VILLAGE MILL DR STE R
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4378
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13817 VILLAGE MILL DR STE R
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4378
Practice Address - Country:US
Practice Address - Phone:804-537-2024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014662101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional