Provider Demographics
NPI:1780305151
Name:JORDAN, CORTNEY LAUNA
Entity type:Individual
Prefix:
First Name:CORTNEY
Middle Name:LAUNA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13911 WHEEL WRIGHT PL
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-3792
Mailing Address - Country:US
Mailing Address - Phone:757-761-8389
Mailing Address - Fax:
Practice Address - Street 1:13911 WHEEL WRIGHT PL
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607-3792
Practice Address - Country:US
Practice Address - Phone:757-761-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health