Mitzi Bunch Jordan, LCSWA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P011385 Issued in NC

Practice address

1141 N Road St Ste L
Elizabeth City, NC 27909-3354

Phone

(252) 335-0803

Fax

(252) 413-0932

NPI assigned

Jun 14, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1497398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1497398400000",
    "number": "1043740806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 SAPPHIRE CT STE 110",
            "city": "GREENVILLE",
            "state": "NC",
            "postal_code": "278349079",
            "telephone_number": "252-830-7540",
            "fax_number": "252-413-0932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1141 N ROAD ST STE L",
            "city": "ELIZABETH CITY",
            "state": "NC",
            "postal_code": "279093354",
            "telephone_number": "252-335-0803",
            "fax_number": "252-413-0932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "MITZI",
        "middle_name": "BUNCH",
        "credential": "LCSWA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-14",
        "last_updated": "2017-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P011385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LCSWA LICENSURE",
            "identifier": "P011385",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Jones
• Heather Jones, RBT
• Jason Bradford Jones, D.C.
• Samuel Jones
• Jordan Management Group, LLC
• Sandra S Jordan, M.ED.
• Audrey Maurise Joy, PT
• Roscoe Waylon Joyner III, LPT
• Michael Louis Juliano, MD
• Kaleb C Thompson, DMD, PA Iiii

• Clinical Social Worker in Elizabeth City, NC
• Providers in Elizabeth City, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2017; 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.