Provider Demographics
NPI:1356680763
Name:GRIFFIN, MARK F (EDD, LPC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:F
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:EDD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 FOX HUNTER LN
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:GA
Mailing Address - Zip Code:30528-2372
Mailing Address - Country:US
Mailing Address - Phone:800-287-4802
Mailing Address - Fax:706-348-1353
Practice Address - Street 1:10 S BROOKS ST
Practice Address - Street 2:STE. 4
Practice Address - City:CLEVELAND
Practice Address - State:GA
Practice Address - Zip Code:30528-1151
Practice Address - Country:US
Practice Address - Phone:800-287-4802
Practice Address - Fax:706-348-1353
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC001942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
12496823OtherCAQH
GA003161579AMedicaid