Provider Demographics
NPI:1891263109
Name:GRIFFIN, LATINA MAY (LCSW)
Entity Type:Individual
Prefix:
First Name:LATINA
Middle Name:MAY
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2820 CANYON VALLEY RUN
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3579
Mailing Address - Country:US
Mailing Address - Phone:512-576-5854
Mailing Address - Fax:
Practice Address - Street 1:106 S HARRIS ST STE 234
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-6081
Practice Address - Country:US
Practice Address - Phone:512-576-5854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX604421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical