Provider Demographics
NPI:1972513257
Name:GRIFFITH, THOMAS ALAN (LMSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:ALAN
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4474 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-2235
Mailing Address - Country:US
Mailing Address - Phone:734-740-5090
Mailing Address - Fax:
Practice Address - Street 1:17250 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3151
Practice Address - Country:US
Practice Address - Phone:734-425-4070
Practice Address - Fax:734-425-8350
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010575301041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ26426254Medicare ID - Type Unspecified