| Doctor Name: | MRS. SHAVONDA DENISE JORDAN |
| NPI Number: | 1225265986 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW, PLCSW,LCASA |
| License Number: | P005024 |
| Business Practice Address: | 215 Commerce St Manning, SC - 291022638 |
| Business Phone Number: | 8034352124 |
| Business Fax Number: | 8034358113 |
| Mailing Address: | 215 N Magnolia St, SUMTER |
| State: | SC |
| Postal Code: | 291514943 |
| Phone Number: | 8037759364 |
| Fax Number: | 8037736615 |
| NPI Enumeration Date: | 06/19/2009 |
| NPI Last Update Date: | 10/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | P005024 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |