Doctor Name: | JENNIFER JORDAN |
NPI Number: | 1043641574 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCPC-C, LADC, CCS |
License Number: | LC5235 |
Business Practice Address: | 71 Us Route 1 Scarborough, ME - 040747173 |
Business Phone Number: | 2077739931 |
Business Fax Number: | |
Mailing Address: | 18 Ocean St Apt 25, SOUTH PORTLAND |
State: | ME |
Postal Code: | 041062853 |
Phone Number: | 2072724112 |
Fax Number: | |
NPI Enumeration Date: | 12/10/2013 |
NPI Last Update Date: | 12/10/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | LC5235 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |