Provider Demographics
NPI:1952749566
Name:JORDAN, ELISABETH MONTGOMERY (LPC)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:MONTGOMERY
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 CARRIAGE HOUSE LN
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-2752
Mailing Address - Country:US
Mailing Address - Phone:803-669-3546
Mailing Address - Fax:
Practice Address - Street 1:1902 CARRIAGE HOUSE LN
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2752
Practice Address - Country:US
Practice Address - Phone:803-669-3546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional