Healthcare Provider Details

I. General information

NPI: 1356680763
Provider Name (Legal Business Name): MARK F. GRIFFIN ED.D., LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 S BROOKS ST STE. 4
CLEVELAND GA
30528-1151
US

IV. Provider business mailing address

45 FOX HUNTER LN
CLEVELAND GA
30528-2372
US

V. Phone/Fax

Practice location:
  • Phone: 800-287-4802
  • Fax: 706-348-1353
Mailing address:
  • Phone: 800-287-4802
  • Fax: 706-348-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC001942
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: