Individual
MS. JAQUITA GWYNN JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., L.P.C.
Contact information
Practice address
300 S 4TH ST, LEESVILLE, LA 71446-4318
(337) 424-7406
Mailing address
PO BOX 431, NEW LLANO, LA 71461-0431
(337) 424-7406
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3044
LA
Other
Enumeration date
02/12/2007
Last updated
08/04/2011
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