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NPI Code Detail

MEDICARE: JASMINE JANEA SMITH

MEDICARE: JASMINE JANEA SMITH
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
1106S00000XBehavior Technician
2247200000XOther Technician
3101YM0800XMental Health CounselorA18736NC

General Provider Information

NPI Number : 1689035065
Entity Type Code : Individual
Provider Name (Legal Business Name) : JASMINE JANEA SMITH
Provider Business Mailing Address
First Line : 280 EXECUTIVE PARK DR STE 100
Second Line :
City : CONCORD
State : NC
Zip : 28025-1838
Country : US
Telephone Number : 704-237-4240
Fax Number :
Provider Business Practice Location Address
First Line : 280 EXECUTIVE PARK DR STE 100
Second Line :
City : CONCORD
State : NC
Zip : 28025-1838
Country : US
Telephone Number : 704-237-4240
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2016
Last Update Date : 05/05/2023

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Directions to “ JASMINE JANEA SMITH ” Practice Location

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