Provider Demographics
NPI:1750178968
Name:JORDE, THERESA (LLMSW)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:JORDE
Suffix:
Gender:
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5558 UNION ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48450-8828
Mailing Address - Country:US
Mailing Address - Phone:810-679-1261
Mailing Address - Fax:810-679-1261
Practice Address - Street 1:5558 UNION ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MI
Practice Address - Zip Code:48450-8828
Practice Address - Country:US
Practice Address - Phone:810-679-1261
Practice Address - Fax:810-679-1261
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511098221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical