Healthcare Provider Details

I. General information

NPI: 1720428980
Provider Name (Legal Business Name): COURTNEE NIA JORDAN-COX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 PINE BRIDGE LN
LANCASTER PA
17603-9009
US

IV. Provider business mailing address

PO BOX 1707
BEAR DE
19701-7707
US

V. Phone/Fax

Practice location:
  • Phone: 414-723-8481
  • Fax:
Mailing address:
  • Phone: 717-723-8481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number23783
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: