Healthcare Provider Details

I. General information

NPI: 1154087252
Provider Name (Legal Business Name): JASMINE TERRY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 GLENRIDGE DR STE 230
SANDY SPRINGS GA
30328-9929
US

IV. Provider business mailing address

5887 GLENRIDGE DR STE 230
SANDY SPRINGS GA
30328-9929
US

V. Phone/Fax

Practice location:
  • Phone: 404-490-2926
  • Fax:
Mailing address:
  • Phone: 404-490-2926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCSW008937
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: