Individual
DELLA N JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CDCA
Contact information
Practice address
10050 BASSETT RD, ATHENS, OH 45701-3626
(740) 594-8108
(740) 594-0268
Mailing address
224 COLUMBUS RD, ATHENS, OH 45701-1334
(740) 592-6724
(740) 592-6728
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
021111
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2864002
—
OH
Enumeration date
03/20/2018
Last updated
06/16/2018
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