Healthcare Provider Details

I. General information

NPI: 1427719962
Provider Name (Legal Business Name): ANGELA DENISE JORDAN-BARNES LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 WAYNE MEMORIAL DR STE E
GOLDSBORO NC
27534-2203
US

IV. Provider business mailing address

1503 WAYNE MEMORIAL DR STE E
GOLDSBORO NC
27534-2203
US

V. Phone/Fax

Practice location:
  • Phone: 919-587-0001
  • Fax:
Mailing address:
  • Phone: 919-587-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17089
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: