Provider Demographics
NPI:1356807093
Name:GRIFFITH, JENNIFER ANDERSON
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANDERSON
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3438 CHAPEL HILLS PKWY
Mailing Address - Street 2:
Mailing Address - City:FULTONDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35068-6081
Mailing Address - Country:US
Mailing Address - Phone:205-910-0905
Mailing Address - Fax:
Practice Address - Street 1:701 MONTGOMERY HWY STE 202
Practice Address - Street 2:
Practice Address - City:VESTAVIA HILLS
Practice Address - State:AL
Practice Address - Zip Code:35216-1839
Practice Address - Country:US
Practice Address - Phone:205-916-0123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC3145A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health