Provider Demographics
NPI:1467881375
Name:GRIFFIN, VICTORIA (MED, LPC, MAC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MED, LPC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725331
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31139-2331
Mailing Address - Country:US
Mailing Address - Phone:678-439-7022
Mailing Address - Fax:678-819-4994
Practice Address - Street 1:3400 CHAPEL HILL RD STE 304
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1739
Practice Address - Country:US
Practice Address - Phone:678-575-5322
Practice Address - Fax:678-819-4994
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006788101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional