Provider Demographics
NPI:1255748026
Name:JORDAN, JANELL LAFAYE (LPC)
Entity type:Individual
Prefix:MS
First Name:JANELL
Middle Name:LAFAYE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1348 WESTGATE CENTER DR UNIT 439
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-2984
Mailing Address - Country:US
Mailing Address - Phone:336-341-5354
Mailing Address - Fax:336-450-1504
Practice Address - Street 1:1348 WESTGATE CENTER DR STE 204
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2984
Practice Address - Country:US
Practice Address - Phone:336-341-5354
Practice Address - Fax:336-450-1504
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10855101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional