Provider Demographics
NPI:1861108243
Name:GRIFFIN, KELLY A
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:A
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 1:1237 SAINT ANN ST
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2407
Mailing Address - Country:US
Mailing Address - Phone:504-373-4226
Mailing Address - Fax:
Practice Address - Street 1:1042 ANNUNCIATION ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-3831
Practice Address - Country:US
Practice Address - Phone:504-303-4646
Practice Address - Fax:504-910-9773
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty