Provider Demographics
NPI:1225455769
Name:DEAL, JORDAN CHRISTOPHER
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:CHRISTOPHER
Last Name:DEAL
Suffix:
Gender:M
Credentials:
Other - Prefix:MS
Other - First Name:SABRINA
Other - Middle Name:RAY
Other - Last Name:DEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:368 FELL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5144
Mailing Address - Country:US
Mailing Address - Phone:415-861-0828
Mailing Address - Fax:415-861-0257
Practice Address - Street 1:405 BAKER ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1403
Practice Address - Country:US
Practice Address - Phone:415-346-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-22
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor