Provider Demographics
NPI:1417984477
Name:GRIFFIN, BRENT G (LPC, LSATP)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:G
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:LPC, LSATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 EXECUTIVE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6604
Mailing Address - Country:US
Mailing Address - Phone:757-827-7707
Mailing Address - Fax:757-838-2573
Practice Address - Street 1:2202 EXECUTIVE DR
Practice Address - Street 2:STE C
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6604
Practice Address - Country:US
Practice Address - Phone:757-827-7707
Practice Address - Fax:757-838-2573
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003062101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA100068902OtherAMERICAN PSYC SYS
VA485730OtherVALUE OPTIONS
VA328200OtherMANAGED HN/TRICARE
VA010122112OtherFIRST HEALTH
VA233861OtherCOM PSYCH
VAO80156MOtherSENTARA HEALTH MANAGEMENT
VA284106000OtherMAGELLAN
VA191689OtherANTHEM
VA7258325OtherAETNA