Healthcare Provider Details

I. General information

NPI: 1457044646
Provider Name (Legal Business Name): JASMINE SPRUILL MS, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 MAIN ST
COLUMBIA NC
27925-8351
US

IV. Provider business mailing address

PO BOX 381
COLUMBIA NC
27925-0381
US

V. Phone/Fax

Practice location:
  • Phone: 252-706-7337
  • Fax:
Mailing address:
  • Phone: 252-216-6124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP018909
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: