Provider Demographics
NPI:1700474855
Name:VICKERS, JASMINE (RBT)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:VICKERS
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 HANDLEY RD STE C
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-2178
Mailing Address - Country:US
Mailing Address - Phone:770-430-2960
Mailing Address - Fax:888-981-1653
Practice Address - Street 1:190 HANDLEY RD STE C
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-2178
Practice Address - Country:US
Practice Address - Phone:770-430-2960
Practice Address - Fax:888-981-1653
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-25-83727103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst