Healthcare Provider Details

I. General information

NPI: 1285569723
Provider Name (Legal Business Name): JORDAN NICOLE SMALLWOOD LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7406 CHAPEL HILL RD STE J
RALEIGH NC
27607-5039
US

IV. Provider business mailing address

7406 CHAPEL HILL RD STE J
RALEIGH NC
27607-5039
US

V. Phone/Fax

Practice location:
  • Phone: 919-726-4005
  • Fax: 919-573-0438
Mailing address:
  • Phone:
  • Fax: 919-573-0438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberP023820
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: