Healthcare Provider Details

I. General information

NPI: 1770488967
Provider Name (Legal Business Name): JORDAN CONKLIN, LMFT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 INDEPENDENCE BLVD STE 100-54
WILMINGTON NC
28412-2571
US

IV. Provider business mailing address

609 PINER RD STE A 579
WILMINGTON NC
28409-4201
US

V. Phone/Fax

Practice location:
  • Phone: 910-777-7597
  • Fax:
Mailing address:
  • Phone: 910-777-7597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: JORDAN CONKLIN
Title or Position: OWNER
Credential: LMFT
Phone: 910-777-7597