Provider Demographics
NPI:1407548563
Name:GRIFFIN, ANNDRAJA (RBT)
Entity Type:Individual
Prefix:
First Name:ANNDRAJA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 BORRACLOUGH AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-1832
Mailing Address - Country:US
Mailing Address - Phone:321-704-2385
Mailing Address - Fax:407-960-3009
Practice Address - Street 1:541 BORRACLOUGH AVE NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1832
Practice Address - Country:US
Practice Address - Phone:321-704-2385
Practice Address - Fax:407-960-3009
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician