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General NPI Number Information
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NPI Number | 1114475563
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Entity Type | Individual
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Provider Name | JASMINE V MCCULLY LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 1835 SAVOY DR
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City | ATLANTA
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State | GA
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Zip | 30341-1072
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Country | US
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Telephone | 219-484-5904
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 90265
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City | EAST POINT
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State | GA
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Zip | 30364-0265
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Country | US
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Telephone | 219-484-5904
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Fax | 888-773-1428
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34009515A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801107178
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149021602
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW006990
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License Number State | GA
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