Provider Demographics
NPI:1609554062
Name:GOINS, JORDAN A (LSW)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:A
Last Name:GOINS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:IN
Mailing Address - Zip Code:47635-1504
Mailing Address - Country:US
Mailing Address - Phone:812-686-3837
Mailing Address - Fax:
Practice Address - Street 1:506 S 4TH ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1504
Practice Address - Country:US
Practice Address - Phone:812-686-3837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33008449A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker