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General NPI Number Information
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NPI Number | 1497253728
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Entity Type | Individual
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Provider Name | LISA GRIFKA LMSW
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Gender | Female
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 02/01/2018
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Provider Practice Location Address
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Address Line | 1115 S VAN DYKE RD STE 1
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City | BAD AXE
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State | MI
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Zip | 48413-9615
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Country | US
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Telephone | 810-689-4846
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Fax | 810-958-1430
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Provider Business Mailing Address
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Address Line | 1017 S LAKESHORE RD
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City | CARSONVILLE
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State | MI
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Zip | 48419-9494
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Country | US
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Telephone | 810-689-4846
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Fax | 910-958-1430
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801094799
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License Number State | MI
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