| Doctor Name: | JAMES RAYMOND JORDAN |
| NPI Number: | 1023397387 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MS, NCC, LMHC,DCC |
| License Number: | |
| Business Practice Address: | 595 Route 25a Suite #15 Miller Place, NY - 117642646 |
| Business Phone Number: | 6317860842 |
| Business Fax Number: | 6317759284 |
| Mailing Address: | Po Box 63, MIDDLE ISLAND |
| State: | NY |
| Postal Code: | 119530063 |
| Phone Number: | 6316085202 |
| Fax Number: | 6312644509 |
| NPI Enumeration Date: | 08/04/2011 |
| NPI Last Update Date: | 04/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |