Provider Demographics
NPI:1083683387
Name:GRIFFEN, SALLY DIANN (LCPC, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:DIANN
Last Name:GRIFFEN
Suffix:
Gender:F
Credentials:LCPC, LMFT
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:DIANN
Other - Last Name:MARCEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC, LMFT
Mailing Address - Street 1:SEVEN BLANCHARD CIRCLE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2039
Mailing Address - Country:US
Mailing Address - Phone:630-653-2300
Mailing Address - Fax:630-653-2895
Practice Address - Street 1:SEVEN BLANCHARD CIRCLE
Practice Address - Street 2:SUITE 201
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2039
Practice Address - Country:US
Practice Address - Phone:630-653-2300
Practice Address - Fax:630-653-2895
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003758101Y00000X
IL166000540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02215643OtherBLUE CROSS BLUE SHIELD