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General NPI Number Information
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NPI Number | 1427787159
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Entity Type | Individual
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Provider Name | JORDAN ASHLEY DUDLEY LCSW-A
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Gender | Female
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 06/09/2022
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Provider Practice Location Address
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Address Line | 2457 GUM BRANCH RD STE 800
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City | JACKSONVILLE
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State | NC
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Zip | 28540-4008
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Country | US
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Telephone | 910-238-2774
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Fax |
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Provider Business Mailing Address
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Address Line | 305 HIGH STEPPER CT
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City | JACKSONVILLE
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State | NC
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Zip | 28540-8007
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Country | US
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Telephone | 909-730-0997
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P017579
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P017579
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License Number State | NC
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