Basic Information
| Provider Information | |||||||||
| NPI: | 1043712136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARMSTRONG | ||||||||
| FirstName: | JASMYN | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8202 WESLEY PROVIDENCE PKWY | ||||||||
| Address2: | |||||||||
| City: | STONECREST | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300386966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4702078072 | ||||||||
| FaxNumber: | 6783834556 | ||||||||
| Practice Location | |||||||||
| Address1: | 2711 IRVIN WAY | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300305405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8665234268 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2018 | ||||||||
| LastUpdateDate: | 06/27/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/27/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | 17-43363 | GA | N | 103K00000X | 1-21-50505 | GA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.