Provider Demographics
NPI:1962292102
Name:JORDAN, SOPHIA (LMSW)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 S HIGHWAY 161 APT 1203
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-9002
Mailing Address - Country:US
Mailing Address - Phone:214-970-4698
Mailing Address - Fax:
Practice Address - Street 1:3711 S HIGHWAY 161 APT 1203
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-9002
Practice Address - Country:US
Practice Address - Phone:214-970-4698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-10
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115252104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker