Healthcare Provider Details

I. General information

NPI: 1649182205
Provider Name (Legal Business Name): JASMYN TROY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 MALLARD CREEK RD STE 300
CHARLOTTE NC
28262-6001
US

IV. Provider business mailing address

316 OAKWOOD CREEK LN APT T101
CHARLOTTE NC
28262-1192
US

V. Phone/Fax

Practice location:
  • Phone: 919-807-1692
  • Fax:
Mailing address:
  • Phone: 704-582-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number20940A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: