Provider Demographics
NPI:1548982598
Name:GRIFFIN, LATORI (PHD, LMFT, NCC)
Entity type:Individual
Prefix:
First Name:LATORI
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PHD, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3885 NW 24TH BLVD APT 307
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-5675
Mailing Address - Country:US
Mailing Address - Phone:305-527-3228
Mailing Address - Fax:
Practice Address - Street 1:1301 RIVERPLACE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9032
Practice Address - Country:US
Practice Address - Phone:833-351-8255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001662106H00000X
FLMT4458106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist