Healthcare Provider Details

I. General information

NPI: 1467291658
Provider Name (Legal Business Name): MAHA MOHAMMAD BILAL GRIFFIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10179 FAIRHILL DR
SPRING VALLEY CA
91977-6534
US

IV. Provider business mailing address

10179 FAIRHILL DR
SPRING VALLEY CA
91977-6534
US

V. Phone/Fax

Practice location:
  • Phone: 773-655-1564
  • Fax:
Mailing address:
  • Phone: 773-655-1564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number137902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: