Provider Demographics
NPI:1457515108
Name:GRIFFIN, NARISSA RAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:NARISSA
Middle Name:RAE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NARISSA
Other - Middle Name:RAE
Other - Last Name:HUTCHINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:5401 ROGERS AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3763
Mailing Address - Country:US
Mailing Address - Phone:479-242-4560
Mailing Address - Fax:479-242-4561
Practice Address - Street 1:5401 ROGERS AVE STE 201
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903
Practice Address - Country:US
Practice Address - Phone:479-242-4560
Practice Address - Fax:479-242-4561
Is Sole Proprietor?:No
Enumeration Date:2008-07-11
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR11-21P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR190433719Medicaid
AR3C986Medicare PIN