Provider Demographics
NPI:1497124531
Name:ROBERTS, JAZMIN (LCMHC)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 EVANSTON VIEW RD APT O
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4415
Mailing Address - Country:US
Mailing Address - Phone:352-451-3256
Mailing Address - Fax:
Practice Address - Street 1:7490 WATERSIDE CROSSING BLVD STE 2A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-3004
Practice Address - Country:US
Practice Address - Phone:704-360-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19406101YM0800X
FLMH15073101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health