# JORDANICA INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043515570
- **Authorized official:** MARK A. PREMSELAAR LCSW (PRESIDENT)
- **Authorized official phone:** (702) 358-0464

## Contact information

- **Practice address:** 780 CORONADO CENTER DR, SUITE 110A, HENDERSON, NV 89052-5040
- **Practice address phone:** (702) 358-0464
- **Practice address fax:** (610) 432-3508
- **Mailing address:** 780 CORONADO CENTER DR, SUITE 110A, HENDERSON, NV 89052-5040
- **Mailing address phone:** (702) 358-0464
- **Mailing address fax:** (610) 432-3508

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | 5782C | NV | Yes |

## Other

- **Enumeration date:** 01/13/2011
- **Last updated:** 01/13/2011