MEDICARE: JASMINE ROCHELLE GARRISON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCAS-25624	NC
2	171M00000X	Case Manager/Care Coordinator
3	101YM0800X	Mental Health Counselor	14018	NC

General Provider Information

NPI Number	:	1528594959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE ROCHELLE GARRISON

Provider Business Mailing Address
First Line	:	6522 PEPPERBUSH CT
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28262-4229
Country	:	US
Telephone Number	:	513-461-4918
Fax Number	:

Provider Business Practice Location Address
First Line	:	5820 E W T HARRIS BLVD STE 205
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-4032
Country	:	US
Telephone Number	:	704-469-1243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	02/22/2023

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