=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245041102
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JASMINE DEAUNDRA BURNS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2025
-----------------------------------------------------
Last Update Date | 01/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3255 LANDMARK DR STE 206
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29418-8573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-964-8007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 407 THOROUGHBRED DR
-----------------------------------------------------
City | MONCKS CORNER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29461-6891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-312-4725
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 10222
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------