Provider Demographics
NPI:1003167339
Name:JORDAN, ASHLEY (LCSW, PIP)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 871
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36831-0871
Mailing Address - Country:US
Mailing Address - Phone:334-329-6063
Mailing Address - Fax:972-499-1005
Practice Address - Street 1:118 N. ROSS
Practice Address - Street 2:SUITE 2
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-4869
Practice Address - Country:US
Practice Address - Phone:334-332-5214
Practice Address - Fax:334-329-6063
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-26
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2853G1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical