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General NPI Number Information
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NPI Number | 1376379453
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Entity Type | Individual
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Provider Name | JORDAN BLADE KENNINGTON
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Gender | Female
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Dates
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Enumeration Date | 09/13/2024
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 850 WADE HAMPTON BLVD
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City | GREENVILLE
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State | SC
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Zip | 29609-4945
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Country | US
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Telephone | 704-981-1558
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Fax |
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Provider Business Mailing Address
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Address Line | 15 RODNEY AVE
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City | GREENVILLE
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State | SC
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Zip | 29617-7618
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Country | US
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Telephone | 478-258-3346
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Fax |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 9278
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License Number State | SC
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