Provider Demographics
NPI:1770933095
Name:JORDAN, NICOLE M (LPC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 ROUTE 68
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:15066-4213
Mailing Address - Country:US
Mailing Address - Phone:724-601-7662
Mailing Address - Fax:
Practice Address - Street 1:410 E GRANDVIEW AVE # A-2
Practice Address - Street 2:
Practice Address - City:ZELIENOPLE
Practice Address - State:PA
Practice Address - Zip Code:16063-1211
Practice Address - Country:US
Practice Address - Phone:724-601-7662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional