Provider Demographics
NPI:1306382205
Name:GRIFFIN, ELIZABETH DELAINE (LMHC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:DELAINE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 MASHBURN RD
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32448-5483
Mailing Address - Country:US
Mailing Address - Phone:850-573-1422
Mailing Address - Fax:
Practice Address - Street 1:2540 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-0102
Practice Address - Country:US
Practice Address - Phone:850-573-1422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-16
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7596101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health