Provider Demographics
NPI:1407319825
Name:ELLIOTT-MIXON, JORDEN ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:JORDEN
Middle Name:ANNE
Last Name:ELLIOTT-MIXON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:JORDEN
Other - Middle Name:ANNE
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:312 BROWNS HILL CT
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-9511
Mailing Address - Country:US
Mailing Address - Phone:804-893-5555
Mailing Address - Fax:804-893-5553
Practice Address - Street 1:312 BROWNS HILL CT
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-9511
Practice Address - Country:US
Practice Address - Phone:804-893-5555
Practice Address - Fax:804-893-5553
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional