Provider Demographics
NPI:1881361541
Name:JORDAN, ABIGAIL LEI (BCBA)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LEI
Last Name:JORDAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 VILLA WAY UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-6582
Mailing Address - Country:US
Mailing Address - Phone:352-279-1699
Mailing Address - Fax:
Practice Address - Street 1:1311 VILLA WAY UNIT A
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-6582
Practice Address - Country:US
Practice Address - Phone:352-279-1699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-23-66728103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst