Doctor Name: | MR. PHILLIP ANTHONY JORDINELLI |
NPI Number: | 1144669466 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CDCII |
License Number: | 2279 |
Business Practice Address: | 3449 E Rezanof Dr Kodiak, AK - 996156952 |
Business Phone Number: | 9074869823 |
Business Fax Number: | 9074869898 |
Mailing Address: | 3449 E Rezanof Dr, KODIAK |
State: | AK |
Postal Code: | 996156952 |
Phone Number: | 9074869800 |
Fax Number: | 9074869898 |
NPI Enumeration Date: | 06/19/2013 |
NPI Last Update Date: | 06/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 2279 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |