Individual
MRS. HOLLY MICHELLE JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LICSW, AADC
Contact information
Practice address
97 GREAT TEAYS BLVD STE 6, SCOTT DEPOT, WV 25560-9816
(304) 757-6999
(304) 757-3252
Mailing address
97 GREAT TEAYS BLVD STE 6, SCOTT DEPOT, WV 25560-9816
(304) 757-6999
(304) 757-3252
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1648
NC
1041C0700X
Clinical Social Worker
Primary
DP00943969
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013229327
—
WV
05
—
3810023874
—
WV
Enumeration date
07/02/2010
Last updated
08/02/2019
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