Healthcare Provider Details

I. General information

NPI: 1770245193
Provider Name (Legal Business Name): ANDREA JORDAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 MERCURY CIR
GULF SHORES AL
36542-3338
US

IV. Provider business mailing address

3905 MERCURY CIR
GULF SHORES AL
36542-3338
US

V. Phone/Fax

Practice location:
  • Phone: 251-202-9221
  • Fax: 888-892-3951
Mailing address:
  • Phone: 251-202-9221
  • Fax: 888-892-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC05778
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number17040
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: