Provider Demographics
NPI:1679693634
Name:GRIFFITH, CAROL (LCPC)
Entity Type:Individual
Prefix:MISS
First Name:CAROL
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 WINGATE LN
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5708
Mailing Address - Country:US
Mailing Address - Phone:208-884-4676
Mailing Address - Fax:208-338-6887
Practice Address - Street 1:485 W MAIN ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7244
Practice Address - Country:US
Practice Address - Phone:208-338-1712
Practice Address - Fax:208-338-6887
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC78101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health