Provider Demographics
NPI:1346767365
Name:JORDAN, ANGELA D (CDCA)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:D
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:D
Other - Last Name:HARMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDCA
Mailing Address - Street 1:923 SUNRISE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:OH
Mailing Address - Zip Code:45693-1143
Mailing Address - Country:US
Mailing Address - Phone:937-544-5547
Mailing Address - Fax:
Practice Address - Street 1:923 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-1143
Practice Address - Country:US
Practice Address - Phone:937-544-5547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH130991101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)