Healthcare Provider Details

I. General information

NPI: 1104953835
Provider Name (Legal Business Name): MILLICENT C. JORDAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CARRIAGE LN BLDG. J
CHARLESTON SC
29407-6060
US

IV. Provider business mailing address

1 CARRIAGE LN BLDG. J
CHARLESTON SC
29407-6060
US

V. Phone/Fax

Practice location:
  • Phone: 843-573-5050
  • Fax: 843-570-5030
Mailing address:
  • Phone: 843-573-5050
  • Fax: 843-570-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MILLICENT JORDAN
Title or Position: OWNER
Credential: LPC
Phone: 843-573-5050