Provider Demographics
NPI:1720695091
Name:GRIFFIN, CARRI RENE (LMSW)
Entity Type:Individual
Prefix:
First Name:CARRI
Middle Name:RENE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:CARRI
Other - Middle Name:RENE
Other - Last Name:LUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23221 REPUBLIC AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237-2355
Mailing Address - Country:US
Mailing Address - Phone:586-668-6751
Mailing Address - Fax:
Practice Address - Street 1:23221 REPUBLIC AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2355
Practice Address - Country:US
Practice Address - Phone:586-668-6751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010820071041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool