Provider Demographics
NPI:1477938314
Name:JORDAN, DANIEL W (LADAC II, CADC II)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:W
Last Name:JORDAN
Suffix:
Gender:M
Credentials:LADAC II, CADC II
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:W
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:822 CHICKAMAUGA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-1407
Mailing Address - Country:US
Mailing Address - Phone:706-861-6458
Mailing Address - Fax:706-866-6277
Practice Address - Street 1:822 CHICKAMAUGA AVE
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-1407
Practice Address - Country:US
Practice Address - Phone:706-861-6458
Practice Address - Fax:706-866-6277
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YA0400X
GA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)