Provider Demographics
NPI:1356899348
Name:JORDAN, ASHA T
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:T
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 FLORIN RD
Mailing Address - Street 2:APT 29
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-2075
Mailing Address - Country:US
Mailing Address - Phone:916-712-2558
Mailing Address - Fax:
Practice Address - Street 1:12631 IMPERIAL HWY STE C103
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-6735
Practice Address - Country:US
Practice Address - Phone:562-406-7385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program