| NPI | 1023366101 |
|---|---|
| Former Name | BEVERLY LOUISE JORDAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: PA PC005975) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: PA PC005975) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2012-08-21 |