Individual
JASMINE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCMHCA
Contact information
Practice address
2504 RAEFORD RD STE 202, FAYETTEVILLE, NC 28305-5135
(910) 644-9986
Mailing address
2504 RAEFORD RD STE 202, FAYETTEVILLE, NC 28305-5135
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
A16576
NC
103K00000X
Behavior Analyst
Primary
—
—
103TS0200X
School Psychologist
—
SC
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LP1033
—
SC
Enumeration date
09/05/2018
Last updated
04/10/2024
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