Provider Demographics
NPI:1205455912
Name:DESAI, JORDAN (LISW-CP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:DESAI
Suffix:
Gender:F
Credentials:LISW-CP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:A
Other - Last Name:MIRAGLIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW-CP
Mailing Address - Street 1:826 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1732
Mailing Address - Country:US
Mailing Address - Phone:301-758-5202
Mailing Address - Fax:
Practice Address - Street 1:826 MAPLE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1732
Practice Address - Country:US
Practice Address - Phone:301-758-5202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC100481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical