Provider Demographics
NPI:1821407073
Name:JORDAN, FATIMA (LPC, CRC, LCASA)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPC, CRC, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 W CONE BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-4047
Mailing Address - Country:US
Mailing Address - Phone:336-410-4161
Mailing Address - Fax:
Practice Address - Street 1:2309 W CONE BLVD STE 218
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-4047
Practice Address - Country:US
Practice Address - Phone:336-410-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22225101YA0400X
NC00117659225C00000X
NCA10358101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor