Healthcare Provider Details

I. General information

NPI: 1962181578
Provider Name (Legal Business Name): MIA MARSHEA JORDAN MA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIA MARSHEA ANGALICH MA, NCC

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MAIN ST STE 104
WHEELING WV
26003-2737
US

IV. Provider business mailing address

1100 MAIN ST STE 104
WHEELING WV
26003-2737
US

V. Phone/Fax

Practice location:
  • Phone: 304-460-5123
  • Fax:
Mailing address:
  • Phone: 304-460-5123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberC4A14700158
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3138
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: