Provider Demographics
NPI:1821310970
Name:DUKE, JORDAN BLAKE (MS, CRC, QP, LCAS-P)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:BLAKE
Last Name:DUKE
Suffix:
Gender:F
Credentials:MS, CRC, QP, LCAS-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 CHARLES BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5924
Mailing Address - Country:US
Mailing Address - Phone:252-215-5711
Mailing Address - Fax:252-215-5701
Practice Address - Street 1:2428 CHARLES BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5924
Practice Address - Country:US
Practice Address - Phone:252-215-5711
Practice Address - Fax:252-215-5701
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional