MEDICARE: JORDAN CONKLIN LMFTA

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	106H00000X	Marriage & Family Therapist	20395A	NC

General Provider Information

NPI Number	:	1831906841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN CONKLIN LMFTA

Provider Business Mailing Address
First Line	:	2142 WISTERIA DR
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28401-7321
Country	:	US
Telephone Number	:	336-404-3705
Fax Number	:

Provider Business Practice Location Address
First Line	:	890 S KERR AVE STE 250
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-2573
Country	:	US
Telephone Number	:	919-909-1230
Fax Number	:

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

Provider Enumeration Date	:	12/12/2024
Last Update Date	:	12/12/2024

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Directions to “ JORDAN CONKLIN LMFTA” Practice Location

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