Provider Demographics
NPI:1255874061
Name:GRIFFIN, ANTARIAN T
Entity type:Individual
Prefix:MR
First Name:ANTARIAN
Middle Name:T
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 1:10584 HWY 33
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241
Mailing Address - Country:US
Mailing Address - Phone:318-278-3766
Mailing Address - Fax:
Practice Address - Street 1:102 W BAYOU ST
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-2802
Practice Address - Country:US
Practice Address - Phone:318-368-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2024-04-22
Deactivation Date:2024-04-10
Deactivation Code:
Reactivation Date:2024-04-22
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health