Provider Demographics
NPI:1902272131
Name:STOLTZFUS HUTSON, JORDAN GWYN (MA/EDS, LPCA, NCC)
Entity Type:Individual
Prefix:MRS
First Name:JORDAN
Middle Name:GWYN
Last Name:STOLTZFUS HUTSON
Suffix:
Gender:F
Credentials:MA/EDS, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4813 LOFF ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28642-9411
Mailing Address - Country:US
Mailing Address - Phone:336-467-0368
Mailing Address - Fax:
Practice Address - Street 1:4813 LOFF ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28642-9411
Practice Address - Country:US
Practice Address - Phone:336-467-0368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11752101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health