Provider Demographics
NPI:1306375563
Name:GRIFFIN, COREYANNE L (LICSW, PMH-C, SUDP)
Entity Type:Individual
Prefix:
First Name:COREYANNE
Middle Name:L
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LICSW, PMH-C, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 GRAND AVE STE 303A
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-3586
Mailing Address - Country:US
Mailing Address - Phone:425-298-5583
Mailing Address - Fax:
Practice Address - Street 1:5931 140TH ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-9444
Practice Address - Country:US
Practice Address - Phone:425-298-5583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-09
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006101101YA0400X
WASC604914261041C0700X
WALW60819530104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1790826600Medicaid