Provider Demographics
NPI:1730628819
Name:GRIFFITH, NICOLE LEIGH (LISW)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEIGH
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LEIGH
Other - Last Name:HAWLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:2098 PORTAGE RD STE 125
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-5707
Mailing Address - Country:US
Mailing Address - Phone:330-641-5696
Mailing Address - Fax:
Practice Address - Street 1:2098 PORTAGE RD STE 125
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-5707
Practice Address - Country:US
Practice Address - Phone:330-641-5696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-22
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.21025441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0275748Medicaid