Healthcare Provider Details

I. General information

NPI: 1336774678
Provider Name (Legal Business Name): MR. LECLETUS GRIFFIN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2020
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 40TH ST
OAKLAND CA
94609-2633
US

IV. Provider business mailing address

390 40TH ST
OAKLAND CA
94609-2633
US

V. Phone/Fax

Practice location:
  • Phone: 510-569-4589
  • Fax:
Mailing address:
  • Phone: 510-569-4589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPCC21805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: