Provider Demographics
NPI:1831906841
Name:CONKLIN, JORDAN (LMFTA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:CONKLIN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2142 WISTERIA DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7321
Mailing Address - Country:US
Mailing Address - Phone:336-404-3705
Mailing Address - Fax:
Practice Address - Street 1:890 S KERR AVE STE 250
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2573
Practice Address - Country:US
Practice Address - Phone:919-909-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20395A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist