Provider Demographics
NPI:1073647376
Name:GRIFFIN, THEDA NIGEL (MED)
Entity Type:Individual
Prefix:MS
First Name:THEDA
Middle Name:NIGEL
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S.WILLOW STREET
Mailing Address - Street 2:APT 10-304
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247
Mailing Address - Country:US
Mailing Address - Phone:720-747-4134
Mailing Address - Fax:
Practice Address - Street 1:4141 EAST DICKENSON PLACE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222
Practice Address - Country:US
Practice Address - Phone:303-504-6603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health