Provider Demographics
NPI:1649069089
Name:COLE, JORDAN MICHAEL (CIT)
Entity type:Individual
Prefix:MR
First Name:JORDAN
Middle Name:MICHAEL
Last Name:COLE
Suffix:
Gender:
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 HOLIDAY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-5282
Mailing Address - Country:US
Mailing Address - Phone:504-677-8474
Mailing Address - Fax:
Practice Address - Street 1:201 HOLIDAY BLVD STE 400
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5282
Practice Address - Country:US
Practice Address - Phone:504-677-8474
Practice Address - Fax:985-273-3869
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACIT-5453101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)