Individual
CHARLES JORDAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4124 LINDEN AVE, DAYTON, OH 45432-3018
(937) 522-0869
Mailing address
4124 LINDEN AVE, DAYTON, OH 45432-3018
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
04/13/2018
Last updated
04/13/2018
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