Provider Demographics
NPI:1467097170
Name:GRIFFIN, NICOLE (PLPC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13135 NORTHVIEW HEIGHTS CT
Mailing Address - Street 2:
Mailing Address - City:BLACK JACK
Mailing Address - State:MO
Mailing Address - Zip Code:63033-4565
Mailing Address - Country:US
Mailing Address - Phone:314-283-3517
Mailing Address - Fax:
Practice Address - Street 1:737 DUNN RD
Practice Address - Street 2:
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-1740
Practice Address - Country:US
Practice Address - Phone:314-699-4746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor