Individual
DEREK R. JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
25 WHITNEY DR STE 122, MILFORD, OH 45150-8400
(513) 941-4999
(513) 694-0168
Mailing address
6460 HARRISON AVE STE 200, CINCINNATI, OH 45247-7958
(513) 941-4999
(513) 694-0168
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDCII.121091
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
LCDCIII.121091
OH
101YA0400X
Addiction (Substance Use Disorder) Counselor
LICDC.161401
OH
101YP2500X
Professional Counselor
C.1600018
OH
101YP2500X
Professional Counselor
Primary
E.2303715-SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0218756
—
OH
Enumeration date
02/15/2017
Last updated
05/29/2025
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