Provider Demographics
NPI:1912619073
Name:JORDAN, JENNIFER (ALC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N ROYAL ST STE 507
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36602-3610
Mailing Address - Country:US
Mailing Address - Phone:251-978-6221
Mailing Address - Fax:
Practice Address - Street 1:118 N ROYAL ST STE 507
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36602-3610
Practice Address - Country:US
Practice Address - Phone:251-978-6221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3780A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health