Provider Demographics
NPI:1568209591
Name:PEARSON, JORDAN LEE
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:LEE
Last Name:PEARSON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JORDAN
Other - Middle Name:LEE
Other - Last Name:PEARSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 POMEROY RD APT A3
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-8501
Mailing Address - Country:US
Mailing Address - Phone:740-463-2404
Mailing Address - Fax:
Practice Address - Street 1:184 HOLIDAY HILLS DR
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26104-8006
Practice Address - Country:US
Practice Address - Phone:304-699-4233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)