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General NPI Number Information
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NPI Number | 1255810081
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Entity Type | Individual
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Provider Name | KIMBERLY GARDNER JORDAN MCLEOD MSW
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Gender | Female
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 5663 S LABURNUM AVE
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City | RICHMOND
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State | VA
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Zip | 23231-4418
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Country | US
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Telephone | 804-737-3917
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Fax | 804-737-3940
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Provider Business Mailing Address
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Address Line | 5663 S LABURNUM AVE
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City | RICHMOND
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State | VA
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Zip | 23231-4418
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Country | US
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Telephone | 804-737-3917
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Fax | 804-737-3940
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0134000663
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License Number State | VA
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