Provider Demographics
NPI:1700958071
Name:ORNDORFF, JAIMIE C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAIMIE
Middle Name:C
Last Name:ORNDORFF
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 RANDALL PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2827
Mailing Address - Country:US
Mailing Address - Phone:910-515-4556
Mailing Address - Fax:910-446-3668
Practice Address - Street 1:4910 RANDALL PKWY STE B
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2827
Practice Address - Country:US
Practice Address - Phone:910-515-4556
Practice Address - Fax:910-446-3668
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TH0100X, 1041C0700X, 101YP2500X
NC4233103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912545260OtherNPI2