Provider Demographics
NPI:1710233051
Name:JORDAN, THOMAS H JR (LCADC - NJ)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:H
Last Name:JORDAN
Suffix:JR
Gender:M
Credentials:LCADC - NJ
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-2539
Mailing Address - Country:US
Mailing Address - Phone:732-899-1511
Mailing Address - Fax:732-892-0984
Practice Address - Street 1:302 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BEACH
Practice Address - State:NJ
Practice Address - Zip Code:08742-2539
Practice Address - Country:US
Practice Address - Phone:732-899-1511
Practice Address - Fax:732-892-0984
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00180300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)