| Doctor Name: | THOMAS H JORDAN |
| NPI Number: | 1710233051 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCADC - NJ |
| License Number: | 37LC00180300 |
| Business Practice Address: | 302 Hawthorne Ave Point Pleasant Beach, NJ - 087422539 |
| Business Phone Number: | 7328991511 |
| Business Fax Number: | 7328920984 |
| Mailing Address: | 302 Hawthorne Ave, POINT PLEASANT BEACH |
| State: | NJ |
| Postal Code: | 087422539 |
| Phone Number: | 7328991511 |
| Fax Number: | 7328920984 |
| NPI Enumeration Date: | 07/24/2012 |
| NPI Last Update Date: | 07/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 37LC00180300 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |