MEDICARE: MS. JASMINE SHAVON BETHEA MSW,LCSW,LCAS-A,LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-28029	NC
2	1041C0700X	Clinical Social Worker	C018890	NC
3	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		NC

General Provider Information

NPI Number	:	1184984510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JASMINE SHAVON BETHEA MSW,LCSW,LCAS-A,LSW

Provider Business Mailing Address
First Line	:	8041 BRIER CREEK PKWY
Second Line	:	# 1046
City	:	DURHAM
State	:	NC
Zip	:	27703-2680
Country	:	US
Telephone Number	:	919-408-4945
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 ONYX CT
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27703-2680
Country	:	US
Telephone Number	:	919-408-4945
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2012
Last Update Date	:	12/10/2025

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