Provider Demographics
NPI:1710107990
Name:GRIFFIN, CAROLYN J (MA)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:J
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 INDEX PL NE
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-4025
Mailing Address - Country:US
Mailing Address - Phone:206-818-8537
Mailing Address - Fax:
Practice Address - Street 1:1300 114TH AVE SE
Practice Address - Street 2:SUITE 108
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6942
Practice Address - Country:US
Practice Address - Phone:206-817-8537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00042776101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health