Provider Demographics
NPI:1952066052
Name:JORDAN, NADINE (CSAC)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CSAC
Other - Prefix:
Other - First Name:NADINE
Other - Middle Name:
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3208 HERSHBERGER RD NW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24017-1842
Mailing Address - Country:US
Mailing Address - Phone:540-202-2397
Mailing Address - Fax:540-366-5211
Practice Address - Street 1:3208 HERSHBERGER RD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017-1842
Practice Address - Country:US
Practice Address - Phone:540-202-2397
Practice Address - Fax:540-366-5211
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710103507101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)