Provider Demographics
NPI:1083226948
Name:BROOKS, JORDAN ALFORD (LPC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ALFORD
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CRIMORA MINE RD
Mailing Address - Street 2:
Mailing Address - City:CRIMORA
Mailing Address - State:VA
Mailing Address - Zip Code:24431-2523
Mailing Address - Country:US
Mailing Address - Phone:540-649-2576
Mailing Address - Fax:
Practice Address - Street 1:500 OLD LYNCHBURG RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-6500
Practice Address - Country:US
Practice Address - Phone:434-964-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009827101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional