Provider Demographics
NPI:1629465505
Name:JORDAN, PATTI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATTI
Middle Name:
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 1:7118 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WADE
Mailing Address - State:NC
Mailing Address - Zip Code:28395-9749
Mailing Address - Country:US
Mailing Address - Phone:910-483-6694
Mailing Address - Fax:
Practice Address - Street 1:7118 MAIN ST
Practice Address - Street 2:
Practice Address - City:WADE
Practice Address - State:NC
Practice Address - Zip Code:28395-9749
Practice Address - Country:US
Practice Address - Phone:910-483-6694
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-18
Last Update Date:2015-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0011671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical