Healthcare Provider Details

I. General information

NPI: 1235616228
Provider Name (Legal Business Name): LINDSAY ANN-SISCO JORDAN M.ED, ATR, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS LINDSAY ANN SISCO

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 HEALY DR STE 204
WINSTON SALEM NC
27103-1568
US

IV. Provider business mailing address

3030 KONNOAK DR
WINSTON SALEM NC
27127-4831
US

V. Phone/Fax

Practice location:
  • Phone: 336-815-5570
  • Fax: 888-253-5636
Mailing address:
  • Phone: 336-963-9293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14941
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: