Provider Demographics
NPI:1245821230
Name:JORDAN, STEFANYA CAMILLE (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:STEFANYA
Middle Name:CAMILLE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17330 PRESTON RD STE 240B
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6075
Mailing Address - Country:US
Mailing Address - Phone:817-760-3467
Mailing Address - Fax:
Practice Address - Street 1:17330 PRESTON RD STE 240B
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75252-6075
Practice Address - Country:US
Practice Address - Phone:817-760-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-01
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15260101YA0400X
TX83934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)