1457654741 NPI number — DORALISSA R. GRIFFIN MS, LMHCA, CERTIFIED

Table of content: DORALISSA R. GRIFFIN MS, LMHCA, CERTIFIED (NPI 1457654741)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457654741 NPI number — DORALISSA R. GRIFFIN MS, LMHCA, CERTIFIED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFIN
Provider First Name:
DORALISSA
Provider Middle Name:
R.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LMHCA, CERTIFIED
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRIFFIN
Provider Other First Name:
LISSA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LMHC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457654741
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13114 4TH DR SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERETT
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98208-6431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-478-7670
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2722 COLBY AVE
Provider Second Line Business Practice Location Address:
STE. #328
Provider Business Practice Location Address City Name:
EVERETT
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98201-3557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-478-7670
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2010

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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