Provider Demographics
NPI:1205967890
Name:GRIFFIN, DENISE (CADC, ICADC,)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:CADC, ICADC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 W CHICKASAW AVE
Mailing Address - Street 2:
Mailing Address - City:SALLISAW
Mailing Address - State:OK
Mailing Address - Zip Code:74955-7201
Mailing Address - Country:US
Mailing Address - Phone:918-775-2657
Mailing Address - Fax:918-775-0439
Practice Address - Street 1:1515 W CHICKASAW AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-7201
Practice Address - Country:US
Practice Address - Phone:918-775-2657
Practice Address - Fax:918-775-0439
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK246101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)