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NPI Code Detail

MEDICARE: NICOLE GRIFFIN

MEDICARE:   NICOLE  GRIFFIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1669741708
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE GRIFFIN
Provider Business Mailing Address
First Line : 201 W PLYMOUTH AVE
Second Line :
City : DELAND
State : FL
Zip : 32720-2753
Country : US
Telephone Number : 386-873-2963
Fax Number : 386-873-2786
Provider Business Practice Location Address
First Line : 201 W PLYMOUTH AVE
Second Line :
City : DELAND
State : FL
Zip : 32720-2753
Country : US
Telephone Number : 386-873-2963
Fax Number : 386-873-2786
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2011
Last Update Date : 04/15/2013

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Directions to “ NICOLE GRIFFIN ” Practice Location

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