Individual
JORDAN TYLER DEWITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MA, LMFT, LCAS
Contact information
Practice address
651 JONES SPRINGS CHURCH RD, ELLERBE, NC 28338-8413
(910) 318-7416
Mailing address
651 JONES SPRINGS CHURCH RD, ELLERBE, NC 28338-8413
(910) 318-7416
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCAS-24343
NC
106H00000X
Marriage & Family Therapist
12093A
NC
106H00000X
Marriage & Family Therapist
Primary
2160
NC
Other
Enumeration date
05/22/2018
Last updated
01/06/2022
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