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General NPI Number Information
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NPI Number | 1336785864
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Entity Type | Individual
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Provider Name | JASMINE LEWIS PRITTS LICSW
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Gender | Female
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Dates
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Enumeration Date | 11/19/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 3000 COOMBS FARM RD STE 102
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City | MORGANTOWN
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State | WV
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Zip | 26508-1190
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Country | US
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Telephone | 304-241-1097
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Fax |
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Provider Business Mailing Address
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Address Line | 2956 POINT MARION RD
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City | MORGANTOWN
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State | WV
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Zip | 26505-2944
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Country | US
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Telephone | 301-697-1806
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Fax |
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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 | DP00945509
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License Number State | WV
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