Provider Demographics
NPI:1871247890
Name:GRIFFIN, KELLY JADE (MA, RMHCI)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JADE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MA, RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S PINE ISLAND RD
Mailing Address - Street 2:SUITE 300 UNIT 94
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-860-3742
Mailing Address - Fax:
Practice Address - Street 1:150 S PINE ISLAND RD
Practice Address - Street 2:SUITE 300 UNIT 94
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-860-3742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22153101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health