Healthcare Provider Details

I. General information

NPI: 1285567313
Provider Name (Legal Business Name): KIMBERLY KATHERINE JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S FOURTH ST STE A
MEBANE NC
27302-2653
US

IV. Provider business mailing address

410 BANKS ST
GRAHAM NC
27253-2906
US

V. Phone/Fax

Practice location:
  • Phone: 919-649-3952
  • Fax: 336-376-6425
Mailing address:
  • Phone: 919-649-3952
  • Fax: 336-376-6425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA23034
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: