Healthcare Provider Details

I. General information

NPI: 1689584310
Provider Name (Legal Business Name): SHACHET JORDAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121A BELLEVUE RD
DUBLIN GA
31021-2998
US

IV. Provider business mailing address

2625 SEVEN OAKS RD
WAYNESBORO GA
30830-5101
US

V. Phone/Fax

Practice location:
  • Phone: 478-275-6850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC017327
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: