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General NPI Number Information
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NPI Number | 1477686178
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Entity Type | Individual
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Provider Name | JORDON NICOLE TROMBLEY MA, TLLP
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 271 S MAIN ST
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City | PLYMOUTH
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State | MI
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Zip | 48170-1637
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Country | US
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Telephone | 734-455-4095
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Fax |
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Provider Business Mailing Address
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Address Line | 3031 GLENVIEW AVE
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City | ROYAL OAK
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State | MI
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Zip | 48073-3118
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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 | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | 6301013263
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License Number State | MI
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