Provider Demographics
NPI:1346037173
Name:MCCLAIN, JORDAN ANTHONY (LMBT)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:ANTHONY
Last Name:MCCLAIN
Suffix:
Gender:
Credentials:LMBT
Other - Prefix:MR
Other - First Name:JORDAN
Other - Middle Name:ANTHONY
Other - Last Name:MCCLAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMBT
Mailing Address - Street 1:10339 GOLD PAN RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-8640
Mailing Address - Country:US
Mailing Address - Phone:704-689-0024
Mailing Address - Fax:
Practice Address - Street 1:7928 COUNCIL PL STE 106
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5154
Practice Address - Country:US
Practice Address - Phone:704-689-0024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15022225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist