Provider Demographics
NPI:1205356334
Name:GRIFFIN, PEARL LAVERN (MA, LCASA)
Entity Type:Individual
Prefix:
First Name:PEARL
Middle Name:LAVERN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7003 WALLACE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-6880
Mailing Address - Country:US
Mailing Address - Phone:704-536-6853
Mailing Address - Fax:704-536-6045
Practice Address - Street 1:7003 WALLACE RD STE 100
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-6880
Practice Address - Country:US
Practice Address - Phone:704-536-6853
Practice Address - Fax:704-536-6045
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23328101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)