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Individual
MRS. MILLICENT CLEMONS JORDAN
Active
Individual
MRS. MILLICENT CLEMONS JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
2623
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202569
MEDICAID HO
SC
Enumeration date
04/20/2006
Last updated
07/31/2008
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