Provider Demographics
NPI:1770029381
Name:MCDONALD-GRIFFIN, KEISHA (LPC)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:MCDONALD-GRIFFIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 HALL ST SW STE 112J
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-6501
Mailing Address - Country:US
Mailing Address - Phone:616-719-7164
Mailing Address - Fax:
Practice Address - Street 1:401 HALL ST SW STE 112J
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-6501
Practice Address - Country:US
Practice Address - Phone:616-719-7164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-06
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
MI6401018534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other