Provider Demographics
NPI:1992482590
Name:ROELS, JORDAN NICOLE (LCMHCA, NCC)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:NICOLE
Last Name:ROELS
Suffix:
Gender:F
Credentials:LCMHCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27293-0607
Mailing Address - Country:US
Mailing Address - Phone:336-249-0237
Mailing Address - Fax:335-780-7344
Practice Address - Street 1:1303 GREENSBORO STREET EXT
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-1924
Practice Address - Country:US
Practice Address - Phone:336-249-0237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-05
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA17823101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health