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Individual

JORDAN TYLER DEWITT

Active
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Individual

JORDAN TYLER DEWITT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MA, LMFT, LCAS

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-24343
NC
106H00000X
Marriage & Family Therapist
12093A
NC
106H00000X
Marriage & Family Therapist
Primary
2160
NC

Other

Enumeration date
05/22/2018
Last updated
01/06/2022
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