Holly Michelle Jordan, MSW, LICSW, AADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

DP00943969 Issued in WV

Practice address

97 Great Teays Blvd Ste 6
Scott Depot, WV 25560-9816

Phone

(304) 757-6999

Fax

(304) 757-3252

NPI assigned

Jul 2, 2010

Last updated

Aug 2, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Womencare Inc

  dba FamilyCare

  • Federally Qualified Health Center (FQHC)
  • Winfield, WV
  • NPI 1477834216
  NPD
• Womencare Inc

  dba FamilyCare

  • Federally Qualified Health Center (FQHC)
  • Charleston, WV
  • NPI 1770745036
  NPD
• Womencare Inc

  dba FamilyCare Health Center

  • Federally Qualified Health Center (FQHC)
  • Charleston, WV
  • NPI 1871872184
  NPD
• Womencare, Inc

  dba FamilyCare HealthCenter

  • Federally Qualified Health Center (FQHC)
  • Charleston, WV
  • NPI 1972773224
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1278028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564704000000",
    "number": "1013229327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "97 GREAT TEAYS BLVD STE 6",
            "city": "SCOTT DEPOT",
            "state": "WV",
            "postal_code": "255609816",
            "telephone_number": "304-757-6999",
            "fax_number": "304-757-3252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "97 GREAT TEAYS BLVD STE 6",
            "city": "SCOTT DEPOT",
            "state": "WV",
            "postal_code": "255609816",
            "telephone_number": "304-757-6999",
            "fax_number": "304-757-3252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "HOLLY",
        "middle_name": "MICHELLE",
        "name_prefix": "Mrs.",
        "credential": "MSW, LICSW, AADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-02",
        "last_updated": "2019-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "1648",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WV",
            "license": "DP00943969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013229327",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810023874",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Buffington Jenkins, MD
• Amanda A Johnson, PHARMD.
• Giorgi Lee Johnson, OTD, OTR/L
• Jason Daniel Jones, CASE MANAGER
• Thomas Jones
• Amie Justice
• Susanna A. Kapourales, M.D.
• Katrina Kappen
• Meredith Karnas
• KB Infusion Services, LLC

• Clinical Social Worker in Scott Depot, WV
• Providers in Scott Depot, WV by specialty
• Clinical Social Worker in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.