Individual
DR. AUGUSTUS E. JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
048-0000843
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1010775
—
VT
01
—
68375
BLUE CROSS BLUE SHIELD VT
VT
Enumeration date
07/07/2006
Last updated
07/08/2007
Update your record
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