Provider Demographics
NPI:1225782527
Name:GRIFFIN-JENKINS, CANDI M (LMSW)
Entity Type:Individual
Prefix:
First Name:CANDI
Middle Name:M
Last Name:GRIFFIN-JENKINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 JUSTINE CT
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-9666
Mailing Address - Country:US
Mailing Address - Phone:518-928-0409
Mailing Address - Fax:
Practice Address - Street 1:5 PINE WEST PLZ STE 511
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-5587
Practice Address - Country:US
Practice Address - Phone:518-650-3654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-07
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087129-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health