Provider Demographics
NPI:1881190437
Name:JORDAN, JENNIFER GORDON (EDD, LPC)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:GORDON
Last Name:JORDAN
Suffix:
Gender:F
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3363 LAKEVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-7824
Mailing Address - Country:US
Mailing Address - Phone:706-217-8848
Mailing Address - Fax:
Practice Address - Street 1:1414 DUG GAP RD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-5007
Practice Address - Country:US
Practice Address - Phone:706-279-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009239101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health