Provider Demographics
NPI:1851010995
Name:CROW, JORDAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:
Last Name:CROW
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 CENTERVIEW DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4311
Mailing Address - Country:US
Mailing Address - Phone:501-224-0318
Mailing Address - Fax:
Practice Address - Street 1:1701 CENTERVIEW DR STE 102
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-4311
Practice Address - Country:US
Practice Address - Phone:501-224-0318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2120011101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor