Provider Demographics
NPI:1407309966
Name:JORDAN, CYNTHIA (LISW/LICDCIII)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LISW/LICDCIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5331
Mailing Address - Country:US
Mailing Address - Phone:614-645-6250
Mailing Address - Fax:614-645-1482
Practice Address - Street 1:240 PARSONS AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5331
Practice Address - Country:US
Practice Address - Phone:614-645-6250
Practice Address - Fax:614-645-1482
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00095051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical