Active NPI
Jordan C Poole, LCMHC
- Mental Health Counselor
- Raleigh, NC
National Provider Identifier
1427411339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 12207
- Practice address
- 1631 Midtown PL Ste 104
Raleigh, NC 27609-1300 - Phone
- (336) 684-4106
- NPI assigned
- Mar 30, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 12207 | NC | Primary |
Addresses
Primary practice location
1631 Midtown PL Ste 104
Raleigh, NC 27609-1300
Mailing address
1631 Midtown PL Ste 104
Raleigh, NC 27609-1300
Phone (336) 684-4106
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12207 | NC | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1459296000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688688000000",
"number": "1427411339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1631 MIDTOWN PL STE 104",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276091300",
"telephone_number": "336-684-4106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1631 MIDTOWN PL STE 104",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276091300",
"telephone_number": "336-684-4106"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POOLE",
"first_name": "JORDAN",
"middle_name": "C",
"credential": "LCMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-30",
"last_updated": "2023-07-07",
"certification_date": "2023-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "12207",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.