Provider Demographics
NPI:1013261882
Name:CARROLL, JORDAN NICOLE (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:NICOLE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16430 LEAVITT LN
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-8947
Mailing Address - Country:US
Mailing Address - Phone:405-473-7178
Mailing Address - Fax:704-943-0512
Practice Address - Street 1:21300 CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8505
Practice Address - Country:US
Practice Address - Phone:405-473-7178
Practice Address - Fax:704-943-0512
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor