Provider Demographics
NPI:1225265986
Name:JORDAN, SHAVONDA DENISE (MSW, PLCSW,LCASA)
Entity Type:Individual
Prefix:MRS
First Name:SHAVONDA
Middle Name:DENISE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MSW, PLCSW,LCASA
Other - Prefix:
Other - First Name:SHAVONDA
Other - Middle Name:DENISE
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCASA
Mailing Address - Street 1:215 N MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29151-4943
Mailing Address - Country:US
Mailing Address - Phone:803-775-9364
Mailing Address - Fax:803-773-6615
Practice Address - Street 1:215 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-2638
Practice Address - Country:US
Practice Address - Phone:803-435-2124
Practice Address - Fax:803-435-8113
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-19
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP005024101YM0800X, 104100000X, 1041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker