1912469057 NPI number — MRS. ADELE ANDREA JORDAN LCMHCA

Table of content: MRS. ADELE ANDREA JORDAN LCMHCA (NPI 1912469057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912469057 NPI number — MRS. ADELE ANDREA JORDAN LCMHCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORDAN
Provider First Name:
ADELE
Provider Middle Name:
ANDREA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCMHCA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THORPE
Provider Other First Name:
ADELE
Provider Other Middle Name:
ANDREA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912469057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8924 RAVEN TOP DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINT HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28227-3617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-325-4158
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 GILEAD RD UNIT 1546
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28070-6866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-896-6044
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  A13627 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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