Provider Demographics
NPI:1134648090
Name:HARDMON, JASMINE (BCBA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:HARDMON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 NORMAN RIDGE LN APT 308
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-0657
Mailing Address - Country:US
Mailing Address - Phone:571-435-1146
Mailing Address - Fax:
Practice Address - Street 1:9920 KINCEY AVE STE 150
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-2457
Practice Address - Country:US
Practice Address - Phone:980-202-7432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-17-40438106S00000X
NCBACB304211103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician