Provider Demographics
NPI:1144669466
Name:JORDINELLI, PHILLIP ANTHONY (CDCS, NCACI, SAP)
Entity type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:ANTHONY
Last Name:JORDINELLI
Suffix:
Gender:M
Credentials:CDCS, NCACI, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3449 E REZANOF DR
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6952
Mailing Address - Country:US
Mailing Address - Phone:907-486-7381
Mailing Address - Fax:907-486-7398
Practice Address - Street 1:3449 E REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6952
Practice Address - Country:US
Practice Address - Phone:907-486-9823
Practice Address - Fax:907-486-9898
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2279101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)