Provider Demographics
NPI:1609592997
Name:JORDAN, NYCOLE SHERICE (ALC)
Entity Type:Individual
Prefix:
First Name:NYCOLE
Middle Name:SHERICE
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:PO BOX 9031
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36691-0031
Mailing Address - Country:US
Mailing Address - Phone:251-321-2013
Mailing Address - Fax:
Practice Address - Street 1:600 BEL AIR BLVD STE 128
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606-3501
Practice Address - Country:US
Practice Address - Phone:251-321-2013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC03224101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor