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General NPI Number Information
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NPI Number | 1356717797
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Entity Type | Organization
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Legal Business Name | ERICA R. GRIFFIN LLC
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 561 POOLE MELTON RD
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City | BLYTHE
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State | GA
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Zip | 30805-3813
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Country | US
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Telephone | 773-954-5022
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Fax |
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Provider Business Mailing Address
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Address Line | 561 POOLE MELTON RD
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City | BLYTHE
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State | GA
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Zip | 30805-3813
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Country | US
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Telephone | 773-954-5022
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ERICA R GRIFFIN
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Credential | LPC
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Telephone | 773-954-5022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC007543
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License Number State | GA
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