Provider Demographics
NPI:1336831833
Name:COKER, JORDAN PAIGE (CIT)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:PAIGE
Last Name:COKER
Suffix:
Gender:F
Credentials:CIT
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:PAIGE
Other - Last Name:HENDRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CIT
Mailing Address - Street 1:8260 HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-5421
Mailing Address - Country:US
Mailing Address - Phone:318-535-2979
Mailing Address - Fax:
Practice Address - Street 1:307 HAYES ST
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-2531
Practice Address - Country:US
Practice Address - Phone:318-728-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACIT-5062101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)