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General NPI Number Information
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NPI Number | 1770261844
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Entity Type | Individual
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Provider Name | JASMINE BLANKS
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Gender | Female
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 11770 E FOX CT
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City | ALPHARETTA
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State | GA
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Zip | 30005-7800
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Country | US
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Telephone | 470-254-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 206 SPRING CREEK LN
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City | ATLANTA
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State | GA
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Zip | 30350-3808
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Country | US
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Telephone | 501-607-8997
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT000759
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License Number State | GA
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