Healthcare Provider Details

I. General information

NPI: 1023448297
Provider Name (Legal Business Name): TONYA FELICIA JORDAN MS, LPC, CRC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2013
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 OAKLEIGH LN
DALLAS GA
30132-4462
US

IV. Provider business mailing address

192 OAKLEIGH LN
DALLAS GA
30132-4462
US

V. Phone/Fax

Practice location:
  • Phone: 404-396-4979
  • Fax:
Mailing address:
  • Phone: 404-396-4979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number00073318
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number007521
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: