Provider Demographics
NPI:1609101716
Name:GRIFFITH, KIRK M (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:M
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 STERRETT PL
Mailing Address - Street 2:SUITE 320
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2665
Mailing Address - Country:US
Mailing Address - Phone:410-772-7155
Mailing Address - Fax:410-772-7156
Practice Address - Street 1:5565 STERRETT PL
Practice Address - Street 2:SUITE 320
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2665
Practice Address - Country:US
Practice Address - Phone:410-772-7155
Practice Address - Fax:410-772-7156
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02577103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist