Provider Demographics
NPI:1114098159
Name:GRIFFIN, CAROL JANE (MS)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:JANE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 CHERRY LANE
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071
Mailing Address - Country:US
Mailing Address - Phone:972-542-1123
Mailing Address - Fax:
Practice Address - Street 1:1615 W LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-7857
Practice Address - Country:US
Practice Address - Phone:469-424-1618
Practice Address - Fax:972-542-6198
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10287101YP2500X
TX674106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist