Provider Demographics
NPI:1326657875
Name:JORDAN-HUFFAM OFFICE, JEANETTE MIDDLE (LCMHC)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:MIDDLE
Last Name:JORDAN-HUFFAM OFFICE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 W BENT GRASS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-8791
Mailing Address - Country:US
Mailing Address - Phone:910-308-1641
Mailing Address - Fax:
Practice Address - Street 1:3911 W BENT GRASS DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28312-8791
Practice Address - Country:US
Practice Address - Phone:910-308-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC148101YA0400X
NC821101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)