Provider Demographics
NPI:1851042691
Name:JORDON, RENELL RENEE (CADC, MATS)
Entity Type:Individual
Prefix:
First Name:RENELL
Middle Name:RENEE
Last Name:JORDON
Suffix:
Gender:F
Credentials:CADC, MATS
Other - Prefix:
Other - First Name:RENELL
Other - Middle Name:RENEE
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CADC
Mailing Address - Street 1:8500 BROADWAY STE H
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7006
Mailing Address - Country:US
Mailing Address - Phone:219-769-7710
Mailing Address - Fax:219-769-7758
Practice Address - Street 1:8500 BROADWAY STE H
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7006
Practice Address - Country:US
Practice Address - Phone:219-769-7710
Practice Address - Fax:219-769-7758
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)