Provider Demographics
NPI:1487420303
Name:FARABOW, JORDAN GRACE (LMFTA)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:GRACE
Last Name:FARABOW
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 N DAVIDSON ST UNIT 127
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28205-1088
Mailing Address - Country:US
Mailing Address - Phone:336-906-9606
Mailing Address - Fax:
Practice Address - Street 1:3333 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-6200
Practice Address - Country:US
Practice Address - Phone:704-550-4538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20052A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist