Individual
MRS. SHAVONDA DENISE JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, PLCSW,LCASA
Contact information
Practice address
215 COMMERCE ST, MANNING, SC 29102-2638
(803) 435-2124
(803) 435-8113
Mailing address
215 N MAGNOLIA ST, SUMTER, SC 29151-4943
(803) 775-9364
(803) 773-6615
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
P005024
NC
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
P005024
NC
1041C0700X
Clinical Social Worker
Primary
P005024
NC
Other
Enumeration date
06/19/2009
Last updated
10/29/2014
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