Provider Demographics
NPI:1255842928
Name:GRIFFEY, MARCUS (LMSW)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:GRIFFEY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 FULTON ST. E
Mailing Address - Street 2:STE. B #11
Mailing Address - City:LOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:49331
Mailing Address - Country:US
Mailing Address - Phone:616-344-9690
Mailing Address - Fax:
Practice Address - Street 1:1116 BOWES RD APT 4
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MI
Practice Address - Zip Code:49331-9578
Practice Address - Country:US
Practice Address - Phone:269-362-1507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI680110985104100000X
MI68011065091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1715928Medicaid