Provider Demographics
NPI:1336407048
Name:JORDAN, PAMELA (CAS REGISTERED 12139)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:CAS REGISTERED 12139
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:123 WEST GUTIERREZ ST.
Mailing Address - Street 2:FAMILY SERVICE AGENCY SANTA BARBARA
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101
Mailing Address - Country:US
Mailing Address - Phone:805-965-1001
Mailing Address - Fax:805-965-2178
Practice Address - Street 1:110 S. 'C' ST. STE. A
Practice Address - Street 2:FAMILY SERVICE AGENCY
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436
Practice Address - Country:US
Practice Address - Phone:805-735-4376
Practice Address - Fax:805-737-3251
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12139101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)