Provider Demographics
NPI:1770191207
Name:GRIFFITH, CHRISTINA DENISE
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:DENISE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23011 EASTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SAUK VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60411-4288
Mailing Address - Country:US
Mailing Address - Phone:219-629-5001
Mailing Address - Fax:
Practice Address - Street 1:1820 RIDGE RD STE 303R
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1759
Practice Address - Country:US
Practice Address - Phone:312-818-1260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.011160101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health