Provider Demographics
NPI:1013781533
Name:GRIFFIN, DEKEITRA
Entity Type:Individual
Prefix:MR
First Name:DEKEITRA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 FOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4723
Mailing Address - Country:US
Mailing Address - Phone:469-996-8702
Mailing Address - Fax:
Practice Address - Street 1:1236 SOUTHRIDGE CT STE 207
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4284
Practice Address - Country:US
Practice Address - Phone:877-257-2282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA180881041C0700X
TX1041941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical