Provider Demographics
NPI:1013346782
Name:GRIFFIN, RICHARD (LPC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5924 EDGEMON RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6836
Mailing Address - Country:US
Mailing Address - Phone:423-902-1098
Mailing Address - Fax:
Practice Address - Street 1:5924 EDGEMON RD
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6836
Practice Address - Country:US
Practice Address - Phone:423-902-1098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001538101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional