Provider Demographics
NPI:1104953835
Name:MILLICENT C. JORDAN, LLC
Entity type:Organization
Organization Name:MILLICENT C. JORDAN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILLICENT
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:843-573-5050
Mailing Address - Street 1:1 CARRIAGE LN
Mailing Address - Street 2:BLDG. J
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6060
Mailing Address - Country:US
Mailing Address - Phone:843-573-5050
Mailing Address - Fax:843-570-5030
Practice Address - Street 1:1 CARRIAGE LN
Practice Address - Street 2:BLDG. J
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6060
Practice Address - Country:US
Practice Address - Phone:843-573-5050
Practice Address - Fax:843-570-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty