Provider Demographics
NPI:1699548149
Name:COBB, JASMINE RENAE (ALC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:RENAE
Last Name:COBB
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 1:307 MEADOW CIR
Mailing Address - Street 2:
Mailing Address - City:MAYLENE
Mailing Address - State:AL
Mailing Address - Zip Code:35114-5007
Mailing Address - Country:US
Mailing Address - Phone:205-200-6727
Mailing Address - Fax:
Practice Address - Street 1:7841 1ST AVE N STE 202
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35206-4354
Practice Address - Country:US
Practice Address - Phone:205-810-0906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04655101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health