Provider Demographics
NPI:1598128621
Name:JORDAN, DAWN (ALC)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 CHATEAU DR SW STE 145
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6437
Mailing Address - Country:US
Mailing Address - Phone:256-801-8937
Mailing Address - Fax:256-715-8355
Practice Address - Street 1:250 CHATEAU DR SW STE 145
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6437
Practice Address - Country:US
Practice Address - Phone:256-801-8937
Practice Address - Fax:256-715-8355
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2519A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health