Provider Demographics
NPI:1245625920
Name:JORDAN, ANDRINA (LPC)
Entity type:Individual
Prefix:
First Name:ANDRINA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 931383
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30003
Mailing Address - Country:US
Mailing Address - Phone:678-744-5603
Mailing Address - Fax:877-278-1045
Practice Address - Street 1:801 HAZEN ST
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-2008
Practice Address - Country:US
Practice Address - Phone:269-655-3334
Practice Address - Fax:269-657-6523
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional