Provider Demographics
NPI:1992800593
Name:JORDAN, CANDYCE
Entity type:Individual
Prefix:MS
First Name:CANDYCE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 ROSSCRAGGON RD STE 38C
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1163
Mailing Address - Country:US
Mailing Address - Phone:828-654-7725
Mailing Address - Fax:
Practice Address - Street 1:38 ROSSCRAGGON RD STE 38C
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1163
Practice Address - Country:US
Practice Address - Phone:828-654-7725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1306875695Medicaid