Individual
MR. THEODUS J JORDAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
REVEREND
Contact information
Practice address
804 CENTRE STREET, 300840 --MAILING, JAMAICA PLAIN, MA 02130-0000
(508) 588-6443
(508) 588-6443
Mailing address
P.O.BOX 840, 804 CENTRE STREET, JAMAICA PLAIN, MA 02130-0000
(617) 780-4323
(508) 588-6443
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
—
MA
101YP2500X
Professional Counselor
—
MA
101YP2500X
Professional Counselor
—
—
103K00000X
Behavior Analyst
Primary
—
MA
Other
Enumeration date
06/27/2013
Last updated
06/27/2013
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