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NPI Profile for JORDAN COMMUNITY RESIDENTIAL CENTER in WILLOUGHBY, OH.
A psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral, interpersonal and other problems arising from the addictive behavior.
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Addiction (Substance Use Disorder) |
103TA0400X | 62 | Psychologist, Clinical |
| NPI # | 1164068524 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 11/20/2019 | |
| Last updated | 02/04/2025 - More than a year ago | |
| Sole proprietor 1 | Not specified | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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JORDAN COMMUNITY RESIDENTIAL CENTER