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General NPI Number Information
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NPI Number | 1386267862
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Entity Type | Individual
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Provider Name | WILLIAM ERIKSEN JORDAN
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Gender | Male
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Dates
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Enumeration Date | 05/19/2020
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 2812 DRAKE AVE SW
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City | HUNTSVILLE
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State | AL
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Zip | 35805-5122
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Country | US
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Telephone | 256-529-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 1406 WELLMAN AVE NE
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City | HUNTSVILLE
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State | AL
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Zip | 35801-1934
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | C3458A
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License Number State | AL
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