Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | FL | |
N | 101YP1600X | Pastoral Counselor | FL |
NPI | 1326384934 |
---|---|
Provider Name | Dr. James Robert Jordan |
First Address | Orange Park, FL 32073-4461 |
Second Address | Orange Park, FL 32073-4461 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/12/2012 |
Last Update Date | 31/12/2012 |