Healthcare Provider Details

I. General information

NPI: 1487518064
Provider Name (Legal Business Name): JASMIN OPAL RUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CROWNPOINT EXECUTIVE DR STE 800
CHARLOTTE NC
28227-6727
US

IV. Provider business mailing address

2400 CROWNPOINT EXECUTIVE DR STE 800
CHARLOTTE NC
28227-6727
US

V. Phone/Fax

Practice location:
  • Phone: 828-680-0466
  • Fax: 910-782-2026
Mailing address:
  • Phone: 828-680-0466
  • Fax: 910-782-2026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number20786A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: