Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 007521 | GA |
N | 225C00000X | Rehabilitation Counselor | 00073318 | GA |
NPI | 1023448297 |
---|---|
Provider Name | Mrs. Tonya Felicia Jordan |
First Address | Dallas, GA 30132-4462 |
Second Address | Dallas, GA 30132-4462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2013 |
Last Update Date | 25/11/2013 |