Healthcare Provider Details

I. General information

NPI: 1114799863
Provider Name (Legal Business Name): LETECIA RENEE GRIFFIN ALC03821
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2023
Last Update Date: 10/26/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 PRIVATE ROAD 1601
CHANCELLOR AL
36316-7268
US

IV. Provider business mailing address

930 PRIVATE ROAD 1601
CHANCELLOR AL
36316-7268
US

V. Phone/Fax

Practice location:
  • Phone: 334-237-1093
  • Fax:
Mailing address:
  • Phone: 334-237-1093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberALC03821
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: