Healthcare Provider Details

I. General information

NPI: 1558246751
Provider Name (Legal Business Name): JORDYN RAE SNIPES LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 WOODHILL DR
GASTONIA NC
28054-2466
US

IV. Provider business mailing address

200 E 2ND AVE
GASTONIA NC
28052-4358
US

V. Phone/Fax

Practice location:
  • Phone: 704-866-6295
  • Fax: 704-866-6170
Mailing address:
  • Phone: 704-874-1900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP022626
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: