Active NPI
Samantha M Jordan, CDCA
- Addiction (Substance Use Disorder) Counselor
- Athens, OH
National Provider Identifier
1235648577
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- CDCA.141764
- Practice address
- 11100 State Route 550 Ste H
Athens, OH 45701-8839 - Phone
- (740) 592-1134
- NPI assigned
- Sep 28, 2017
- 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 | CDCA.141764 | OH | Primary |
Addresses
Primary practice location
11100 State Route 550 Ste H
Athens, OH 45701-8839
Mailing address
52189 Rye Rd
Reedsville, OH 45772-9740
Phone (750) 667-0699
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 |
|---|---|---|---|
| CDCA.141764 | OH | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506556800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506556800000",
"number": "1235648577",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "52189 RYE RD",
"city": "REEDSVILLE",
"state": "OH",
"postal_code": "457729740",
"telephone_number": "750-667-0699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11100 STATE ROUTE 550 STE H",
"city": "ATHENS",
"state": "OH",
"postal_code": "457018839",
"telephone_number": "740-592-1134"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "SAMANTHA",
"middle_name": "M",
"name_prefix": "Ms.",
"credential": "CDCA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-09-28",
"last_updated": "2017-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "CDCA.141764",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.