Healthcare Provider Details

I. General information

NPI: 1922858836
Provider Name (Legal Business Name): MS. KENDRA JA'NEE GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 GADSDEN ST STE 101
COLUMBIA SC
29201-6400
US

IV. Provider business mailing address

1911 GADSDEN ST STE 101
COLUMBIA SC
29201-6400
US

V. Phone/Fax

Practice location:
  • Phone: 803-335-5232
  • Fax: 844-617-1550
Mailing address:
  • Phone: 803-335-5232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number30253
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: