Healthcare Provider Details

I. General information

NPI: 1811821713
Provider Name (Legal Business Name): JORDAN WADDELL DANIELS LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E JOPPA RD BLDG B2ND
TOWSON MD
21286-5811
US

IV. Provider business mailing address

11 BIRCHBROOK CT
NOTTINGHAM MD
21236-5006
US

V. Phone/Fax

Practice location:
  • Phone: 443-243-3193
  • Fax:
Mailing address:
  • Phone: 443-686-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34949
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: