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General NPI Number Information
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NPI Number | 1295009439
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Entity Type | Individual
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Provider Name | REGINALD JORDAN MS, LPC, MAC, CPCS,
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Gender | Male
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 30 E WASHINGTON ST UNIT D
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City | NEWNAN
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State | GA
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Zip | 30263-1921
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Country | US
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Telephone | 404-277-8084
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Fax | 678-550-9539
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Provider Business Mailing Address
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Address Line | 30 E WASHINGTON ST UNIT D
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City | NEWNAN
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State | GA
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Zip | 30263-1921
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Country | US
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Telephone | 404-277-8084
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Fax | 678-550-9539
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC007705
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License Number State | GA
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