Provider Demographics
NPI:1336749803
Name:JORDAN, ROY
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:JORDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 GETTIG RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2915
Mailing Address - Country:US
Mailing Address - Phone:202-306-6214
Mailing Address - Fax:
Practice Address - Street 1:2702 BACK ACRE CIR STE 290B
Practice Address - Street 2:
Practice Address - City:MOUNT AIRY
Practice Address - State:MD
Practice Address - Zip Code:21771-7769
Practice Address - Country:US
Practice Address - Phone:301-703-8767
Practice Address - Fax:301-703-8886
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)