Provider Demographics
NPI:1467578740
Name:JORDAN, MARIE ENDY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:ENDY
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:PO BOX 2855
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-0228
Mailing Address - Country:US
Mailing Address - Phone:828-442-5015
Mailing Address - Fax:828-665-4354
Practice Address - Street 1:436 STATE ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:NC
Practice Address - Zip Code:28752-4029
Practice Address - Country:US
Practice Address - Phone:828-442-5015
Practice Address - Fax:828-665-4354
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0030311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002204Medicaid
NC130WUOtherBCBS PROVIDER NUM.
NC6002204Medicaid