MEDICARE: MS. JANELL LAFAYE JORDAN 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	10855	NC

General Provider Information

NPI Number	:	1255748026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANELL LAFAYE JORDAN LPC

Provider Business Mailing Address
First Line	:	1348 WESTGATE CENTER DR UNIT 439
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2984
Country	:	US
Telephone Number	:	336-341-5354
Fax Number	:	336-450-1504

Provider Business Practice Location Address
First Line	:	1348 WESTGATE CENTER DR STE 204
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-2984
Country	:	US
Telephone Number	:	336-341-5354
Fax Number	:	336-450-1504

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

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	08/04/2021

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