Provider Demographics
NPI:1902679293
Name:WARD, JASMINE ANTONEESE (ALC, CCM)
Entity Type:Individual
Prefix:
First Name:JASMINE
Middle Name:ANTONEESE
Last Name:WARD
Suffix:
Gender:F
Credentials:ALC, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-1619
Mailing Address - Country:US
Mailing Address - Phone:205-521-2397
Mailing Address - Fax:
Practice Address - Street 1:1436 HICKORY LN
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-1619
Practice Address - Country:US
Practice Address - Phone:205-521-2397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health