Provider Demographics
NPI:1245810340
Name:JORDAN, HANNAH LEIGH
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:LEIGH
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 W GRACE ST APT 501
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-3659
Mailing Address - Country:US
Mailing Address - Phone:334-444-7428
Mailing Address - Fax:
Practice Address - Street 1:1215 W MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4811
Practice Address - Country:US
Practice Address - Phone:804-355-0201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VARBT-21-163606106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician