Provider Demographics
NPI:1871868356
Name:JORDAN, MICHAEL A (LCSW-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:JORDAN
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1762 SEA PINE CIR
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-1815
Mailing Address - Country:US
Mailing Address - Phone:410-551-2455
Mailing Address - Fax:866-422-6096
Practice Address - Street 1:10015 OLD COLUMBIA RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1703
Practice Address - Country:US
Practice Address - Phone:410-551-2455
Practice Address - Fax:866-422-6096
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12789104100000X
DCLC50078552104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker