Provider Demographics
NPI:1346875036
Name:JORDAN, JALANDA MONANNIQUE (LCSW)
Entity Type:Individual
Prefix:
First Name:JALANDA
Middle Name:MONANNIQUE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 BURTONS CV
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-3182
Mailing Address - Country:US
Mailing Address - Phone:678-437-9987
Mailing Address - Fax:
Practice Address - Street 1:604 BURTONS CV
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-3182
Practice Address - Country:US
Practice Address - Phone:678-437-9987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-03
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0072201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical