MEDICARE: SABRINA JORDAN CAAC ICADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	8899	PA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	8899	PA

General Provider Information

NPI Number	:	1598207680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SABRINA JORDAN CAAC ICADC

Provider Business Mailing Address
First Line	:	145 BRUAW DR
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17406-6502
Country	:	US
Telephone Number	:	717-701-1967
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 BRUAW DR
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17406-6502
Country	:	US
Telephone Number	:	717-701-1967
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2016
Last Update Date	:	11/07/2016

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