Provider Demographics
NPI:1285453852
Name:WHITLEY, JORDAN RAE (MHS, LCMHCA)
Entity type:Individual
Prefix:MS
First Name:JORDAN
Middle Name:RAE
Last Name:WHITLEY
Suffix:
Gender:F
Credentials:MHS, LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 YALE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-9315
Mailing Address - Country:US
Mailing Address - Phone:336-452-8034
Mailing Address - Fax:
Practice Address - Street 1:314 WINSTON RD
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28642-2214
Practice Address - Country:US
Practice Address - Phone:336-818-0733
Practice Address - Fax:336-571-1012
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA20453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health