Provider Demographics
NPI:1578689774
Name:GRIFFIN, SHARON (PHD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:PHILO
Mailing Address - State:IL
Mailing Address - Zip Code:61864-9221
Mailing Address - Country:US
Mailing Address - Phone:217-493-6366
Mailing Address - Fax:
Practice Address - Street 1:100 N CHESTNUT ST STE 244
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-4872
Practice Address - Country:US
Practice Address - Phone:217-493-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004919103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical