MEDICARE: RACHEL JORDAN

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	101YM0800X	Mental Health Counselor	A21541	NC
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1699661959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL JORDAN

Provider Business Mailing Address
First Line	:	620 BUNTING DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-2347
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 BUNTING DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-2347
Country	:	US
Telephone Number	:	910-756-0273
Fax Number	:

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

Provider Enumeration Date	:	06/14/2025
Last Update Date	:	06/14/2025

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Directions to “ RACHEL JORDAN ” Practice Location

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