Provider Demographics
NPI:1831976125
Name:ADCOCK, JORDAN FAYE (LCMHCA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:FAYE
Last Name:ADCOCK
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 LOCKHART ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4001
Mailing Address - Country:US
Mailing Address - Phone:704-698-7934
Mailing Address - Fax:855-515-1826
Practice Address - Street 1:1301 LOCKHART ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4001
Practice Address - Country:US
Practice Address - Phone:704-698-7934
Practice Address - Fax:855-515-1826
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health