Healthcare Provider Details

I. General information

NPI: 1891443628
Provider Name (Legal Business Name): JASMINE NICOLE KINCAID LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2022
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BUFORD HWY NE STE 100
BROOKHAVEN GA
30329-2146
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 678-820-7830
  • Fax:
Mailing address:
  • Phone: 678-820-7830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC012779
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: