Individual
MIKE DEVA JASPER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCAS-A
Contact information
Practice address
2300 SARDIS RD N STE M, CHARLOTTE, NC 28227-7712
(704) 798-4982
Mailing address
13406 TARTARIAN CT, CHARLOTTE, NC 28215-3973
(980) 704-2217
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
25871
NC
Other
Enumeration date
08/26/2024
Last updated
08/26/2024
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