Provider Demographics
NPI:1346831435
Name:JORDAN, KATOYA (LCSWA, LCASA)
Entity Type:Individual
Prefix:MRS
First Name:KATOYA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCSWA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2269 STANTONSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-2841
Mailing Address - Country:US
Mailing Address - Phone:252-439-0700
Mailing Address - Fax:252-439-0900
Practice Address - Street 1:9486 NC-305
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NC
Practice Address - Zip Code:27845
Practice Address - Country:US
Practice Address - Phone:252-534-1088
Practice Address - Fax:252-534-1288
Is Sole Proprietor?:No
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0149241041C0700X
NCLCAS-26600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)