Provider Demographics
NPI:1457654741
Name:GRIFFIN, DORALISSA R (MS)
Entity type:Individual
Prefix:
First Name:DORALISSA
Middle Name:R
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LISSA
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:15405 35TH AVE W APT G35
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-5018
Mailing Address - Country:US
Mailing Address - Phone:425-478-7670
Mailing Address - Fax:
Practice Address - Street 1:7614 195TH ST SW STE 101
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-6260
Practice Address - Country:US
Practice Address - Phone:425-775-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60484698101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health