Healthcare Provider Details

I. General information

NPI: 1922731066
Provider Name (Legal Business Name): JASMINE FERGUSON LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2022
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 MARSHALL AVE STE 900
LAUREL MD
20707-4864
US

IV. Provider business mailing address

3500 OAK LAWN AVE STE 460
DALLAS TX
75219-4717
US

V. Phone/Fax

Practice location:
  • Phone: 800-994-5403
  • Fax:
Mailing address:
  • Phone: 443-483-3093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24032
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: