Provider Demographics
NPI:1265041313
Name:WATKINS, JORDAN (LISW-CP)
Entity type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4841 CHERRY BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8732
Mailing Address - Country:US
Mailing Address - Phone:864-921-0744
Mailing Address - Fax:
Practice Address - Street 1:753 JOHNNIE DODDS BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3054
Practice Address - Country:US
Practice Address - Phone:864-921-0744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty