Healthcare Provider Details

I. General information

NPI: 1518829308
Provider Name (Legal Business Name): NICHOLAS A JORDAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3327 CHETWOOD PL
DUBLIN OH
43017-1635
US

IV. Provider business mailing address

3327 CHETWOOD PL
DUBLIN OH
43017-1635
US

V. Phone/Fax

Practice location:
  • Phone: 614-989-3455
  • Fax:
Mailing address:
  • Phone: 614-989-3455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: