Doctor Name: | MRS. HOLLY MICHELLE JORDAN |
NPI Number: | 1013229327 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW, LICSW, AADC |
License Number: | 1648 |
Business Practice Address: | 301 Great Teays Blvd Ste 6 Scott Depot, WV - 255609552 |
Business Phone Number: | 3047576999 |
Business Fax Number: | 3047573252 |
Mailing Address: | 301 Great Teays Blvd Ste 6, SCOTT DEPOT |
State: | WV |
Postal Code: | 255609552 |
Phone Number: | 3047576999 |
Fax Number: | 3047573252 |
NPI Enumeration Date: | 07/02/2010 |
NPI Last Update Date: | 03/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 1648 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |