Provider Demographics
NPI:1043497449
Name:GRIFFIN, KIMBERLY L (LCSW)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 BATTLEGROUND AVE
Mailing Address - Street 2:134A
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8042
Mailing Address - Country:US
Mailing Address - Phone:336-272-3095
Mailing Address - Fax:336-272-3088
Practice Address - Street 1:1400 BATTLEGROUND AVE
Practice Address - Street 2:134A
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-8042
Practice Address - Country:US
Practice Address - Phone:336-272-3095
Practice Address - Fax:336-272-3088
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0058921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6106881Medicaid
NC2860043Medicare PIN