Provider Information for 1407304702
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Ms. JAZMINE TAWANNA BENNETT CRUMPTON MS, LCMHC, NCC
Sex: Female
NPI: 1407304702
Last Updated: 2025-02-24
Certification Date: 2025-02-24
Certification Date: 2025-02-24
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1407304702 | ||||||||||||
| Enumeration Date | 2016-09-14 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 4045 UNIVERSITY PKWY STE 225 WINSTON SALEM, NC 27106-3325 United States Phone: 336-496-2529 | Fax: | ||||||||||||
| Primary Practice Address | 4045 UNIVERSITY PKWY STE 225 WINSTON SALEM, NC 27106-3325 United States Phone: 336-496-2529 | Fax: | ||||||||||||
| Secondary Practice Address(es) | 3143 S STRATFORD RD 7670 N POINT CT | ||||||||||||
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