Healthcare Provider Details

I. General information

NPI: 1639092448
Provider Name (Legal Business Name): JASMIN OVERSTREET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 TAGGART SPRINGS WAY APT 305
CHARLOTTE NC
28208-0094
US

IV. Provider business mailing address

5050 TAGGART SPRINGS WAY APT 305
CHARLOTTE NC
28208-0094
US

V. Phone/Fax

Practice location:
  • Phone: 980-331-0302
  • Fax:
Mailing address:
  • Phone: 980-331-0302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: