Healthcare Provider Details

I. General information

NPI: 1649159294
Provider Name (Legal Business Name): JORDAN ORGAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN BOWE PSYD

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 PRESIDENT ST
CHARLESTON SC
29425-5712
US

IV. Provider business mailing address

67 PRESIDENT ST
CHARLESTON SC
29425-5712
US

V. Phone/Fax

Practice location:
  • Phone: 936-900-3513
  • Fax:
Mailing address:
  • Phone: 936-900-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number1948
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: