Organization
KATHY Q. JORDAN, LLC
Active
Other names
Kathy Q. Jordan, LCSW, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
KATHY QUARLES JORDAN LCSW (OWNER)
(479) 443-5575
Entity
Organization
Contact information
Practice address
1 W SUNBRIDGE DR, FAYETTEVILLE, AR 72703-1825
(479) 443-5575
(479) 443-9554
Mailing address
1 W SUNBRIDGE DR, FAYETTEVILLE, AR 72703-1825
(479) 443-5575
(479) 443-9554
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1573-C
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1881623197
INDIVIDUAL NPI
—
Enumeration date
09/15/2011
Last updated
09/15/2011
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