Provider Demographics
NPI:1902243587
Name:GRIFFIN-ESSEX, MARISHA LACHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARISHA
Middle Name:LACHELLE
Last Name:GRIFFIN-ESSEX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 451
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63032-0451
Mailing Address - Country:US
Mailing Address - Phone:314-398-9850
Mailing Address - Fax:
Practice Address - Street 1:3159 FEE FEE RD
Practice Address - Street 2:SUITE 206
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-3299
Practice Address - Country:US
Practice Address - Phone:314-398-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110203601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1902243587Medicaid