Provider Demographics
NPI:1538620240
Name:STINSON, JASMINE NICOLE (ALC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:NICOLE
Last Name:STINSON
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 1:1189 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:AL
Mailing Address - Zip Code:35127-2150
Mailing Address - Country:US
Mailing Address - Phone:404-216-1542
Mailing Address - Fax:
Practice Address - Street 1:701 MONTGOMERY HWY
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1847
Practice Address - Country:US
Practice Address - Phone:205-916-0123
Practice Address - Fax:205-916-0878
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3222A101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty