Individual
MS. JILL ELAINE JORDAN
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
L.C.S.W.
Contact information
Practice address
111 HIGHLAND AVE, COLONIAL HEIGHTS, VA 23834-3139
(804) 520-5859
(804) 733-2070
Mailing address
PO BOX 1913, PETERSBURG, VA 23805-0913
(804) 520-5859
(804) 733-2070
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904001306
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00890285
—
VA
01
—
094480
ANTHEM
VA
01
—
542370
MAMSI
VA
Enumeration date
04/25/2006
Last updated
07/08/2007
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