Provider Demographics
NPI:1598765992
Name:GRIFFIN, LISA J (LMSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:61 COMMERCE AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503
Mailing Address - Country:US
Mailing Address - Phone:616-940-0660
Mailing Address - Fax:616-940-1965
Practice Address - Street 1:2060 EAST PARIS AVE SE
Practice Address - Street 2:SUITE 220
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-940-0238
Practice Address - Fax:616-285-7211
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010572331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical