Provider Demographics
NPI:1619654654
Name:BURGOS, JASMINE (MS, LPC)
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:
Last Name:BURGOS
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 CORAL KEY PL APT 3C
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4357
Mailing Address - Country:US
Mailing Address - Phone:856-993-3767
Mailing Address - Fax:
Practice Address - Street 1:700 TECH CENTER PKWY # 200-17
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3075
Practice Address - Country:US
Practice Address - Phone:757-690-1992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-30
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA16486685OtherCAQH