Basic Information
| Provider Information | |||||||||
| NPI: | 1841460078 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFIN | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | TERRI | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 42125 FREEPORT CT | ||||||||
| Address2: | |||||||||
| City: | BELLEVILLE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481112348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135763345 | ||||||||
| FaxNumber: | 3135761091 | ||||||||
| Practice Location | |||||||||
| Address1: | 4646 JOHN R ST | ||||||||
| Address2: | JOHN D. DINGELL VA | ||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3135763345 | ||||||||
| FaxNumber: | 3135761091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2008 | ||||||||
| LastUpdateDate: | 03/04/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801086493 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.