Provider Demographics
NPI:1770350571
Name:HARRIS, JORDAN (LISW-CP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:
Other - Last Name:DOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1393 SMITHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29370-3029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6439 GARNERS FERRY RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29209-1638
Practice Address - Country:US
Practice Address - Phone:803-776-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC163011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical