Provider Demographics
NPI:1003776675
Name:JORDAN, JACQUELINE H (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:H
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TRELAWNEY DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-6890
Mailing Address - Country:US
Mailing Address - Phone:678-516-6418
Mailing Address - Fax:
Practice Address - Street 1:30 TRELAWNEY DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-6890
Practice Address - Country:US
Practice Address - Phone:678-516-6418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-14
Last Update Date:2025-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0004111101YP2500X
GALPC003917101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional