Provider Demographics
NPI:1760518443
Name:GRIFFIN, JACQUELINE LOU (MED, LPC)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:LOU
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25542
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00824-1542
Mailing Address - Country:US
Mailing Address - Phone:340-773-6765
Mailing Address - Fax:
Practice Address - Street 1:227 GOLDEN ROCK
Practice Address - Street 2:SUITE 2
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00824
Practice Address - Country:US
Practice Address - Phone:340-773-6765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 782101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health