Provider Demographics
NPI:1841863925
Name:SALEM MENTAL HEALTH ASSOCIATES PLLC
Entity type:Organization
Organization Name:SALEM MENTAL HEALTH ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCMHC, NCC
Authorized Official - Phone:336-997-7766
Mailing Address - Street 1:1315 CREEKSHIRE WAY APT 439
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4049
Mailing Address - Country:US
Mailing Address - Phone:336-997-7766
Mailing Address - Fax:336-450-1504
Practice Address - Street 1:1348 WESTGATE CENTER DR STE 204
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2984
Practice Address - Country:US
Practice Address - Phone:336-997-7766
Practice Address - Fax:336-450-1504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty