Healthcare Provider Details

I. General information

NPI: 1730889569
Provider Name (Legal Business Name): JASMINE GULLEY CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W MARKET ST STE 102
AKRON OH
44313-7018
US

IV. Provider business mailing address

1815 W MARKET ST STE 102
AKRON OH
44313-7018
US

V. Phone/Fax

Practice location:
  • Phone: 234-340-2138
  • Fax: 330-280-5115
Mailing address:
  • Phone: 234-340-2138
  • Fax: 330-280-5115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.189944
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: