Provider Demographics
NPI:1609384171
Name:JORDAN, NINA (PHD, LPC)
Entity Type:Individual
Prefix:MRS
First Name:NINA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 BANK ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4519
Mailing Address - Country:US
Mailing Address - Phone:757-289-7743
Mailing Address - Fax:
Practice Address - Street 1:132 BANK ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4519
Practice Address - Country:US
Practice Address - Phone:757-289-7743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0701007437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional