MEDICARE: JORDAN ELIZABETH NEELEY 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	7057	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700127594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ELIZABETH NEELEY LPC

Provider Business Mailing Address
First Line	:	1101 OLD TROLLEY RD STE 400
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-5294
Country	:	US
Telephone Number	:	843-212-6802
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 OLD TROLLEY RD STE 400
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-5294
Country	:	US
Telephone Number	:	843-212-6802
Fax Number	:

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

Provider Enumeration Date	:	03/05/2013
Last Update Date	:	03/21/2024

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