Provider Demographics
NPI:1629677166
Name:GLORIS A GRIFFIN COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:GLORIS A GRIFFIN COUNSELING SERVICES, LLC
Other - Org Name:GLORIS A. GRIFFIN CONSULTING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-SUPV, LICDC
Authorized Official - Phone:330-623-5387
Mailing Address - Street 1:5500 MARKET ST STE 106
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-2616
Mailing Address - Country:US
Mailing Address - Phone:330-261-3027
Mailing Address - Fax:
Practice Address - Street 1:5500 MARKET ST STE 106
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-2616
Practice Address - Country:US
Practice Address - Phone:330-261-3027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-24
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0315372Medicaid