Healthcare Provider Details

I. General information

NPI: 1699278077
Provider Name (Legal Business Name): ERICA DENISE GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2018
Last Update Date: 03/14/2022
Certification Date: 03/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 ALTON AVE
COLUMBUS OH
43219-3711
US

IV. Provider business mailing address

1231 NORMAN DR
COLUMBUS OH
43227-1449
US

V. Phone/Fax

Practice location:
  • Phone: 614-258-5086
  • Fax:
Mailing address:
  • Phone: 614-288-0509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: