Provider Demographics
NPI:1790725356
Name:GRIFFIN, JENITA (PSYD, LCP)
Entity Type:Individual
Prefix:DR
First Name:JENITA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PSYD, LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 DERBY MANOR LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-2996
Mailing Address - Country:US
Mailing Address - Phone:301-399-7811
Mailing Address - Fax:301-358-6455
Practice Address - Street 1:4409 FORBES BLVD STE B
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4373
Practice Address - Country:US
Practice Address - Phone:301-399-7811
Practice Address - Fax:301-358-6455
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05323103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1639597859Medicaid