Provider Demographics
NPI:1437385754
Name:GRIFFIN, ALICE WOOD (MA, NBCC, CADC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:WOOD
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MA, NBCC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 HEMLOCK RD
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06783-1409
Mailing Address - Country:US
Mailing Address - Phone:203-788-8785
Mailing Address - Fax:860-210-0129
Practice Address - Street 1:28 HEMLOCK RD
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:CT
Practice Address - Zip Code:06783-1409
Practice Address - Country:US
Practice Address - Phone:203-788-8785
Practice Address - Fax:860-210-0129
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000603101YA0400X
CT000105101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)