Provider Demographics
NPI:1548011588
Name:GRIFFIN, JASMINE ALTAGRACE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:ALTAGRACE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 RAINTREE CIR # 4E
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-1911
Mailing Address - Country:US
Mailing Address - Phone:813-810-2871
Mailing Address - Fax:
Practice Address - Street 1:4 RAINTREE CIR # 4E
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-1911
Practice Address - Country:US
Practice Address - Phone:813-810-2871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)