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General NPI Number Information
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NPI Number | 1235648577
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Entity Type | Individual
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Provider Name | SAMANTHA M JORDAN CDCA
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Gender | Female
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Dates
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Enumeration Date | 09/28/2017
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Last Update Date | 09/28/2017
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Provider Practice Location Address
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Address Line | 11100 STATE ROUTE 550 STE H
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City | ATHENS
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State | OH
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Zip | 45701-8839
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Country | US
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Telephone | 740-592-1134
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Fax |
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Provider Business Mailing Address
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Address Line | 52189 RYE RD
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City | REEDSVILLE
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State | OH
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Zip | 45772-9740
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Country | US
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Telephone | 750-667-0699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.141764
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License Number State | OH
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