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General NPI Number Information
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NPI Number | 1457721060
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Entity Type | Organization
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Legal Business Name | FAITH GRIFFIN GRIFIN THERAPEUTIC SOLUTIONS
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Dates
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Enumeration Date | 09/25/2015
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 405 S 3RD ST
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City | EFFINGHAM
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State | IL
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Zip | 62401-3711
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Country | US
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Telephone | 217-994-4898
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Fax |
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Provider Business Mailing Address
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Address Line | 405 S 3RD ST
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City | EFFINGHAM
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State | IL
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Zip | 62401-3711
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Country | US
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Telephone | 217-994-4898
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | FAITH GRIFFIN
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Credential |
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Telephone | 217-994-4898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180.008480
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License Number State | IL
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