Provider Demographics
NPI:1861283566
Name:JORDAN, DIAMOND BRIANNA
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:BRIANNA
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 1:1955 BELLS FERRY RD APT 1336
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7065
Mailing Address - Country:US
Mailing Address - Phone:404-482-6872
Mailing Address - Fax:
Practice Address - Street 1:1955 BELLS FERRY RD APT 1336
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-7065
Practice Address - Country:US
Practice Address - Phone:404-482-6872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-14
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC015738101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty