1417984477 NPI number — BRENT G GRIFFIN LPC, LSATP

Table of content: BRENT G GRIFFIN LPC, LSATP (NPI 1417984477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417984477 NPI number — BRENT G GRIFFIN LPC, LSATP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFIN
Provider First Name:
BRENT
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, LSATP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417984477
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2202 EXECUTIVE DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
HAMPTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23666-6604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-827-7707
Provider Business Mailing Address Fax Number:
757-838-2573

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2202 EXECUTIVE DR
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
HAMPTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23666-6604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-827-7707
Provider Business Practice Location Address Fax Number:
757-838-2573
Provider Enumeration Date:
06/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701003062 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100068902 . This is a "AMERICAN PSYC SYS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 485730 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 328200 . This is a "MANAGED HN/TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010122112 . This is a "FIRST HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 233861 . This is a "COM PSYCH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: O80156M . This is a "SENTARA HEALTH MANAGEMENT" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 284106000 . This is a "MAGELLAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 191689 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7258325 . This is a "AETNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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