Provider Demographics
NPI:1124513957
Name:BROWN, JORDAN RAINE (MSW, LCSW-A)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:RAINE
Last Name:BROWN
Suffix:
Gender:F
Credentials:MSW, LCSW-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 ALLRED WAY
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-7401
Mailing Address - Country:US
Mailing Address - Phone:336-460-4884
Mailing Address - Fax:
Practice Address - Street 1:895 STATE FARM RD STE 505
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4917
Practice Address - Country:US
Practice Address - Phone:828-268-7200
Practice Address - Fax:828-268-7201
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0124361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical