Provider Demographics
NPI:1780954925
Name:GRIFFIN, LATIFAH
Entity type:Individual
Prefix:
First Name:LATIFAH
Middle Name:
Last Name:GRIFFIN
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 1:1120 EDDYSTONE AVE
Mailing Address - Street 2:APT B-6
Mailing Address - City:EDDYSTONE
Mailing Address - State:PA
Mailing Address - Zip Code:19022-1310
Mailing Address - Country:US
Mailing Address - Phone:610-930-8774
Mailing Address - Fax:
Practice Address - Street 1:1120 EDDYSTONE AVE
Practice Address - Street 2:APT B-6
Practice Address - City:EDDYSTONE
Practice Address - State:PA
Practice Address - Zip Code:19022-1310
Practice Address - Country:US
Practice Address - Phone:610-930-8774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional