Provider Demographics
NPI:1548484132
Name:JORDAN, CLEVEVOYA DALETREASE (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:CLEVEVOYA
Middle Name:DALETREASE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2506 GREENVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-1861
Mailing Address - Country:US
Mailing Address - Phone:678-887-6613
Mailing Address - Fax:404-284-1804
Practice Address - Street 1:127 ENTERPRISE PATH STE 401
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-2698
Practice Address - Country:US
Practice Address - Phone:770-222-6622
Practice Address - Fax:404-284-1804
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0003921101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional