Provider Information for 1548484132
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Mrs. CLEVEVOYA DALETREASE JORDAN LPC, NCC
Sex: Female
NPI: 1548484132
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1548484132 | ||||||||
| Enumeration Date | 2007-04-13 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2506 GREENVILLE WAY DECATUR, GA 30034-1861 United States Phone: 678-887-6613 | Fax:404-284-1804 | ||||||||
| Primary Practice Address | 127 ENTERPRISE PATH STE 401 HIRAM, GA 30141-2698 United States Phone: 770-222-6622 | Fax:404-284-1804 | ||||||||
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