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General NPI Number Information
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NPI Number | 1619543733
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Entity Type | Individual
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Provider Name | JASMINE LATRICE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 05/30/2021
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Last Update Date | 12/26/2025
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Provider Practice Location Address
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Address Line | 1695 KERNERSVILLE MEDICAL PKWY
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City | KERNERSVILLE
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State | NC
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Zip | 27284-7159
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Country | US
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Telephone | 336-515-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 5759 CROSS CREEK CIR APT D
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-4730
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Country | US
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Telephone | 773-682-6691
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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 | C016728
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License Number State | NC
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