Active NPI
Jordan Elliott
- Addiction (Substance Use Disorder) Counselor
- Clarksburg, WV
National Provider Identifier
1043025646
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 25-909SUD
- Practice address
- 6 Hospital PLZ
Clarksburg, WV 26301-9316 - Phone
- (304) 623-5661
- NPI assigned
- Feb 11, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 25-909SUD | WV | Primary |
Addresses
Primary practice location
6 Hospital PLZ
Clarksburg, WV 26301-9316
Mailing address
6 Hospital PLZ
Clarksburg, WV 26301-9316
Phone (304) 623-5661
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25-909SUD | WV | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739232000000",
"number": "1043025646",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6 HOSPITAL PLZ",
"city": "CLARKSBURG",
"state": "WV",
"postal_code": "263019316",
"telephone_number": "304-623-5661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6 HOSPITAL PLZ",
"city": "CLARKSBURG",
"state": "WV",
"postal_code": "263019316",
"telephone_number": "304-623-5661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "JORDAN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-02-11",
"last_updated": "2025-02-11",
"certification_date": "2025-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "WV",
"license": "25-909SUD",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clarksburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.