MEDICARE: MILLICENT C. JORDAN, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	103TC1900X	Counseling Psychologist
3	1041C0700X	Clinical Social Worker
4	2084P0800X	Psychiatry Physician
5	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1104953835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLICENT C. JORDAN, LLC

Provider Business Mailing Address
First Line	:	1 CARRIAGE LN
Second Line	:	BLDG. J
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6060
Country	:	US
Telephone Number	:	843-573-5050
Fax Number	:	843-570-5030

Provider Business Practice Location Address
First Line	:	1 CARRIAGE LN
Second Line	:	BLDG. J
City	:	CHARLESTON
State	:	SC
Zip	:	29407-6060
Country	:	US
Telephone Number	:	843-573-5050
Fax Number	:	843-570-5030

Authorized Official
Title or Position	:	OWNER
Name	:	MILLICENT JORDAN
Credential	:	LPC
Telephone Number	:	843-573-5050

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	09/11/2025

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