Healthcare Provider Details

I. General information

NPI: 1568624732
Provider Name (Legal Business Name): JANICE GRIFFIN PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4004 CARLISLE BLVD NE STE R
ALBUQUERQUE NM
87107-4544
US

IV. Provider business mailing address

4004 CARLISLE BLVD NE STE R
ALBUQUERQUE NM
87107-4544
US

V. Phone/Fax

Practice location:
  • Phone: 505-385-0340
  • Fax: 505-880-1213
Mailing address:
  • Phone: 505-385-0340
  • Fax: 505-880-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1036
License Number StateNM

VIII. Authorized Official

Name: DR. JANICE K GRIFFIN
Title or Position: OWNER
Credential: PH.D
Phone: 505-385-0340