Healthcare Provider Details

I. General information

NPI: 1699365783
Provider Name (Legal Business Name): JASMINE JENKINS LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1942 E 7TH ST STE 220
CHARLOTTE NC
28204-2557
US

IV. Provider business mailing address

PO BOX 675117
DETROIT MI
48267-5117
US

V. Phone/Fax

Practice location:
  • Phone: 704-360-3637
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number23021
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC013477
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: