Provider Demographics
NPI:1336730621
Name:JORDAN-WILLIAMS, CHRISTY L
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:L
Last Name:JORDAN-WILLIAMS
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:PO BOX 292
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29648-0292
Mailing Address - Country:US
Mailing Address - Phone:864-507-9149
Mailing Address - Fax:
Practice Address - Street 1:121 W PUBLIC SQ STE B
Practice Address - Street 2:
Practice Address - City:LAURENS
Practice Address - State:SC
Practice Address - Zip Code:29360-2972
Practice Address - Country:US
Practice Address - Phone:864-507-9149
Practice Address - Fax:864-778-5592
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8925101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPC2938Medicaid
SCSCV568R393OtherMEDICARE