Healthcare Provider Details

I. General information

NPI: 1780503870
Provider Name (Legal Business Name): JASMINE CARNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1437 MILITARY CUTOFF RD STE 210
WILMINGTON NC
28403-3638
US

IV. Provider business mailing address

117 HAMPTON DR
HOLLY RIDGE NC
28445-8835
US

V. Phone/Fax

Practice location:
  • Phone: 910-240-2489
  • Fax:
Mailing address:
  • Phone: 715-497-9474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA22712
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: