Provider Demographics
NPI:1962181578
Name:JORDAN, MIA MARSHEA (MA, NCC)
Entity type:Individual
Prefix:MS
First Name:MIA
Middle Name:MARSHEA
Last Name:JORDAN
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:MARSHEA
Other - Last Name:ANGALICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, NCC
Mailing Address - Street 1:1100 MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2737
Mailing Address - Country:US
Mailing Address - Phone:304-460-5123
Mailing Address - Fax:
Practice Address - Street 1:1100 MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2737
Practice Address - Country:US
Practice Address - Phone:304-460-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV827101YM0800X
WVC4A14700158101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool