Provider Demographics
NPI:1336704055
Name:GRIFFITH, ANDRIA (MA PLPC)
Entity Type:Individual
Prefix:
First Name:ANDRIA
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:MA PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BOARDWALK SPRINGS PL STE 111
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-4777
Mailing Address - Country:US
Mailing Address - Phone:636-887-6414
Mailing Address - Fax:
Practice Address - Street 1:1001 BOARDWALK SPRINGS PL STE 111
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-4777
Practice Address - Country:US
Practice Address - Phone:636-887-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018040827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health