MEDICARE: MS. JORDANNA NICHOLE HERRELL LPC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	7389	SC

General Provider Information

NPI Number	:	1215602842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JORDANNA NICHOLE HERRELL LPC

Provider Business Mailing Address
First Line	:	111 BRICKWORKS DR APT 1302
Second Line	:
City	:	CAYCE
State	:	SC
Zip	:	29033-4433
Country	:	US
Telephone Number	:	803-997-1438
Fax Number	:

Provider Business Practice Location Address
First Line	:	4450 BROAD RIVER RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-4012
Country	:	US
Telephone Number	:	803-896-1314
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2021
Last Update Date	:	08/16/2021

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