Basic Information
| Provider Information | |||||||||
| NPI: | 1972513257 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFITH | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4474 PARKER ST | ||||||||
| Address2: | |||||||||
| City: | DEARBORN HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481252235 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7347405090 | ||||||||
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| Practice Location | |||||||||
| Address1: | 17250 FARMINGTON RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481523151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344254070 | ||||||||
| FaxNumber: | 7344258350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 03/04/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801057530 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.