Healthcare Provider Details

I. General information

NPI: 1447164405
Provider Name (Legal Business Name): JORDIN SANTIAGO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDIN DUNLOP LPC

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 GOSHEN ROAD EXT STE 256
RINCON GA
31326-5575
US

IV. Provider business mailing address

104 BEAUBROOK CT
SPRINGFIELD GA
31329-3938
US

V. Phone/Fax

Practice location:
  • Phone: 912-421-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC017494
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: