Provider Demographics
NPI:1750898326
Name:JORDAN, MICHAEL STEWART (LPC-A)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEWART
Last Name:JORDAN
Suffix:
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2887 BLAIR DR
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-9773
Mailing Address - Country:US
Mailing Address - Phone:828-320-1151
Mailing Address - Fax:
Practice Address - Street 1:393 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28681-4180
Practice Address - Country:US
Practice Address - Phone:828-848-2515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-04
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13423101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health