Provider Demographics
NPI:1225276603
Name:VANDERGRIFF, DANNY HUDSON (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:DANNY
Middle Name:HUDSON
Last Name:VANDERGRIFF
Suffix:
Gender:M
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 W MAGNOLIA AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4345
Mailing Address - Country:US
Mailing Address - Phone:682-465-0942
Mailing Address - Fax:
Practice Address - Street 1:1305 W MAGNOLIA AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4345
Practice Address - Country:US
Practice Address - Phone:682-465-0942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical