Provider Demographics
NPI:1598207680
Name:JORDAN, SABRINA (CAAC ICADC)
Entity Type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CAAC ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 BRUAW DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17406-6502
Mailing Address - Country:US
Mailing Address - Phone:717-701-1967
Mailing Address - Fax:
Practice Address - Street 1:145 BRUAW DR
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17406-6502
Practice Address - Country:US
Practice Address - Phone:717-701-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA8899101Y00000X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor