Individual provider · Type 1 NPI
Tyshonna Domrae Jordan
Mental Health Counselor · Dinwiddie, VA
NPI number
1225546153
Active · reactivated Apr 12, 2021
Practice location
12318 Boydton Plank Rd.
Dinwiddie, VA 23841
Mailing address
5310 Moody Dr
North Dinwiddie, VA 23803-8706
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Counselor Primary | 101YM0800X | None listed |
Mental Health Counselor: Definition to come...
Other mental health counselor providers in Dinwiddie
About NPI 1225546153
Tyshonna Domrae Jordan's National Provider Identifier is 1225546153, issued on Jan 12, 2018. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Dinwiddie, VA. The record was last updated on Apr 12, 2021.