Provider Demographics
NPI:1538930912
Name:PARKER, JASMINE LANAE (LCSWA)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:LANAE
Last Name:PARKER
Suffix:
Gender:F
Credentials:LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 PUDDIN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MOYOCK
Mailing Address - State:NC
Mailing Address - Zip Code:27958-8701
Mailing Address - Country:US
Mailing Address - Phone:304-617-0860
Mailing Address - Fax:
Practice Address - Street 1:4130 CARATOKE HWY STE B
Practice Address - Street 2:
Practice Address - City:BARCO
Practice Address - State:NC
Practice Address - Zip Code:27917-8003
Practice Address - Country:US
Practice Address - Phone:252-421-3179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0200971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical