Healthcare Provider Details

I. General information

NPI: 1003273954
Provider Name (Legal Business Name): NORTHNODE GROUP COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2016
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 S STATE ST
DOVER DE
19901-4948
US

IV. Provider business mailing address

1418 S STATE ST
DOVER DE
19901-4948
US

V. Phone/Fax

Practice location:
  • Phone: 302-257-3135
  • Fax: 302-526-2410
Mailing address:
  • Phone: 302-257-3135
  • Fax: 302-526-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number169824091
License Number StateDE

VIII. Authorized Official

Name: ANTONYA JORDAN
Title or Position: MANAGING PARTNER
Credential:
Phone: 703-565-6278