Provider Demographics
NPI:1972131514
Name:JORDAN, CHERRY M (LADC, CCS, MHRT/C)
Entity Type:Individual
Prefix:
First Name:CHERRY
Middle Name:M
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LADC, CCS, MHRT/C
Other - Prefix:
Other - First Name:CHERRY
Other - Middle Name:M
Other - Last Name:SAUCIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LADC, CCS, MHRT/C
Mailing Address - Street 1:849 STILLWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3624
Mailing Address - Country:US
Mailing Address - Phone:207-573-7941
Mailing Address - Fax:
Practice Address - Street 1:849 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3624
Practice Address - Country:US
Practice Address - Phone:207-573-7941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6149101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)