Individual
TYSHONNA DOMRAE JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12318 BOYDTON PLANK RD., DINWIDDIE, VA 23841
(804) 504-9089
Mailing address
5310 MOODY DR, NORTH DINWIDDIE, VA 23803-8706
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/12/2018
Last updated
04/12/2021
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