Provider Demographics
NPI:1245691831
Name:JORDAN, DIANE KATHRYN (LPC, CCS)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:KATHRYN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPC, CCS
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:KATHRYN
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, CCS
Mailing Address - Street 1:156 NEPTUNE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-2508
Mailing Address - Country:US
Mailing Address - Phone:201-918-6051
Mailing Address - Fax:
Practice Address - Street 1:156 NEPTUNE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-2508
Practice Address - Country:US
Practice Address - Phone:201-918-6051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00098000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional