Basic Information
| Provider Information | |||||||||
| NPI: | 1972062230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFIN | ||||||||
| FirstName: | JACKIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LPC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 GREEN ACRES RD | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295055213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434098057 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 616 S COIT ST | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295015223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436730054 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2019 | ||||||||
| LastUpdateDate: | 03/17/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 7001 | SC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.