Provider Demographics
NPI:1326405184
Name:DESIREE GRIFFIN, M.S., LMHC
Entity Type:Organization
Organization Name:DESIREE GRIFFIN, M.S., LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMHC
Authorized Official - Prefix:MS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:904-759-7462
Mailing Address - Street 1:4609 US HIGHWAY 17
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4818
Mailing Address - Country:US
Mailing Address - Phone:904-759-7462
Mailing Address - Fax:904-269-0021
Practice Address - Street 1:4609 US HIGHWAY 17
Practice Address - Street 2:SUITE 1
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4818
Practice Address - Country:US
Practice Address - Phone:904-759-7462
Practice Address - Fax:904-269-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-25
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4968101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11850334OtherCAQH
FLZ011HOtherBCBS
FL763896500Medicaid