Provider Demographics
NPI:1457132664
Name:GRIFFIN, DESTINY (MS, P-LPC)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS, P-LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 JOE STEVENS RD
Mailing Address - Street 2:
Mailing Address - City:CEDARBLUFF
Mailing Address - State:MS
Mailing Address - Zip Code:39741-8044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 G T THAMES DR
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-9042
Practice Address - Country:US
Practice Address - Phone:662-270-5877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP-0985101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor