Provider Demographics
NPI:1235616228
Name:JORDAN, LINDSAY ANN-SISCO
Entity Type:Individual
Prefix:MRS
First Name:LINDSAY
Middle Name:ANN-SISCO
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LINDSAY
Other - Middle Name:ANN
Other - Last Name:SISCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 FAIRWAY DR STE 102
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441-1817
Mailing Address - Country:US
Mailing Address - Phone:888-880-9270
Mailing Address - Fax:
Practice Address - Street 1:1260 COLLEGE AVE STE 1
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2700
Practice Address - Country:US
Practice Address - Phone:336-818-0733
Practice Address - Fax:336-818-0734
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NCA14941101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA14941OtherLPCA