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NPI Code Detail

MEDICARE: JOSEPH JORDAN PHD

MEDICARE: JOSEPH JORDAN PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor812NC
2101YM0800XMental Health Counselor3889NC

General Provider Information

NPI Number : 1356582670
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH JORDAN PHD
Provider Business Mailing Address
First Line : 1325 LAGERFELD WAY
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-1643
Country : US
Telephone Number : 919-261-7481
Fax Number :
Provider Business Practice Location Address
First Line : 1325 LAGERFELD WAY
Second Line :
City : WAKE FOREST
State : NC
Zip : 27587-1643
Country : US
Telephone Number : 919-261-7481
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2009
Last Update Date : 03/17/2009

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