Provider Demographics
NPI:1497325682
Name:THILL, JORDAN (LCMHCA, CRC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:THILL
Suffix:
Gender:F
Credentials:LCMHCA, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:753 COVERED BRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-6914
Mailing Address - Country:US
Mailing Address - Phone:815-546-2411
Mailing Address - Fax:
Practice Address - Street 1:753 COVERED BRIDGE TRL
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-6914
Practice Address - Country:US
Practice Address - Phone:815-546-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA16592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health