Provider Demographics
NPI:1780945782
Name:GRIFFIS, VALERIE ENRIQUEZ
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:ENRIQUEZ
Last Name:GRIFFIS
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 1:21101 DALE EVANS PKWY
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-9356
Mailing Address - Country:US
Mailing Address - Phone:760-961-6701
Mailing Address - Fax:760-961-6793
Practice Address - Street 1:21101 DALE EVANS PKWY
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-9356
Practice Address - Country:US
Practice Address - Phone:760-961-6701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF73698106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist