Provider Demographics
NPI:1215602842
Name:HERRELL, JORDANNA NICHOLE (LPC)
Entity type:Individual
Prefix:MS
First Name:JORDANNA
Middle Name:NICHOLE
Last Name:HERRELL
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 1:111 BRICKWORKS DR APT 1302
Mailing Address - Street 2:
Mailing Address - City:CAYCE
Mailing Address - State:SC
Mailing Address - Zip Code:29033-4433
Mailing Address - Country:US
Mailing Address - Phone:803-997-1438
Mailing Address - Fax:
Practice Address - Street 1:4450 BROAD RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-4012
Practice Address - Country:US
Practice Address - Phone:803-896-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC7389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional