Individual
MS. MANDY ANN JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CAC II
Contact information
Practice address
1004 CARBON, TRINIDAD, CO 81082-3664
(719) 846-4153
Mailing address
1004 CARBON, TRINIDAD, CO 81082-3664
(719) 846-4153
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
6988
CO
Other
Enumeration date
02/17/2011
Last updated
02/17/2011
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