Provider Demographics
NPI:1790107563
Name:CARLL, JORDAN L (LISW-CP-S, MPH)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:L
Last Name:CARLL
Suffix:
Gender:F
Credentials:LISW-CP-S, MPH
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:L
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 STONERIDGE DR
Mailing Address - Street 2:SUITE 350
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-8200
Mailing Address - Country:US
Mailing Address - Phone:803-779-5500
Mailing Address - Fax:
Practice Address - Street 1:140 STONERIDGE DR
Practice Address - Street 2:SUITE 350
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-8200
Practice Address - Country:US
Practice Address - Phone:803-779-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
SC10508104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical