Organization
BALANCE & VITALITY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FATIMA JORDAN MS, LPC, LCASA (MANAGING MEMBER)
(336) 410-4161
Entity
Organization
Contact information
Practice address
2309 W CONE BLVD STE 218, GREENSBORO, NC 27408-4047
(336) 410-4161
(336) 436-9141
Mailing address
2309 W CONE BLVD STE 218, GREENSBORO, NC 27408-4047
(336) 410-4161
(336) 436-9141
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1821407073
NPI
NC
Enumeration date
07/20/2018
Last updated
07/20/2018
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