Healthcare Provider Details

I. General information

NPI: 1760518443
Provider Name (Legal Business Name): JACQUELINE LOU GRIFFIN M.ED., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 GOLDEN ROCK SUITE 2
CHRISTIANSTED VI
00824
US

IV. Provider business mailing address

PO BOX 25542
CHRISTIANSTED VI
00824-1542
US

V. Phone/Fax

Practice location:
  • Phone: 340-773-6765
  • Fax:
Mailing address:
  • Phone: 340-773-6765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 782
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: