Provider Demographics
NPI:1821681552
Name:JORDAN, STEPHEN (LADC)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 GLEN FALLS RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235-1575
Mailing Address - Country:US
Mailing Address - Phone:603-854-1415
Mailing Address - Fax:
Practice Address - Street 1:419 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NH
Practice Address - Zip Code:03235-1897
Practice Address - Country:US
Practice Address - Phone:603-671-7045
Practice Address - Fax:603-556-8546
Is Sole Proprietor?:No
Enumeration Date:2021-02-13
Last Update Date:2021-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1140101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)