Healthcare Provider Details

I. General information

NPI: 1265440895
Provider Name (Legal Business Name): MARILYN GRIFFIN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W LAFAYETTE ST
COLUMBIA MS
39429-2042
US

IV. Provider business mailing address

PO BOX 965
COLUMBIA MS
39429-0965
US

V. Phone/Fax

Practice location:
  • Phone: 601-736-6799
  • Fax: 601-584-4053
Mailing address:
  • Phone: 601-736-6799
  • Fax: 601-584-4053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM3846
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: