Mike Deva Jasper, LCAS-A
Counselor, Addiction (Substance Use Disorder) in Charlotte, NC. Individual provider (NPI-1).
NPI number1962236737
StatusActive
Last updated in NPPESAug 26, 2024
Details
- NPI
- 1962236737
- Entity type
- Individual (NPI-1)
- Name
- Mike Deva Jasper
- Credential
- LCAS-A
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Aug 26, 2024
- Certification date
- Aug 26, 2024
- Last updated
- Aug 26, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YA0400X | Counselor, Addiction (Substance Use Disorder) | 25871 | NC | Yes |
Practice location
2300 Sardis Rd N Ste MCharlotte, NC 28227-7712
Phone 704-798-4982
Mailing address
13406 Tartarian CtCharlotte, NC 28215-3973
Phone 980-704-2217
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