Healthcare Provider Details

I. General information

NPI: 1578450870
Provider Name (Legal Business Name): DANEISHA GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W MIRIAM AVE
COLUMBIA SC
29203-4038
US

IV. Provider business mailing address

100 OLD CHEROKEE RD # F386
LEXINGTON SC
29072-9316
US

V. Phone/Fax

Practice location:
  • Phone: 803-216-1512
  • Fax:
Mailing address:
  • Phone: 216-258-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number51118
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: