Provider Demographics
NPI:1912469057
Name:JORDAN, ADELE ANDREA (LCMHCA)
Entity type:Individual
Prefix:MRS
First Name:ADELE
Middle Name:ANDREA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:ADELE
Other - Middle Name:ANDREA
Other - Last Name:THORPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8924 RAVEN TOP DR
Mailing Address - Street 2:
Mailing Address - City:MINT HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28227-3617
Mailing Address - Country:US
Mailing Address - Phone:301-325-4158
Mailing Address - Fax:
Practice Address - Street 1:400 GILEAD RD UNIT 1546
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28070-6866
Practice Address - Country:US
Practice Address - Phone:704-896-6044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13627101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional