Provider Demographics
NPI:1457654741
Name:GRIFFIN, DORALISSA R (MS, LMHCA, CERTIFIED)
Entity Type:Individual
Prefix:
First Name:DORALISSA
Middle Name:R
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS, LMHCA, CERTIFIED
Other - Prefix:
Other - First Name:LISSA
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMHC
Mailing Address - Street 1:13114 4TH DR SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6431
Mailing Address - Country:US
Mailing Address - Phone:425-478-7670
Mailing Address - Fax:
Practice Address - Street 1:2722 COLBY AVE
Practice Address - Street 2:STE. #328
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3557
Practice Address - Country:US
Practice Address - Phone:425-478-7670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor