Provider Demographics
NPI:1982318895
Name:GRIFFITH, TYKITTA DONIELLE
Entity type:Individual
Prefix:
First Name:TYKITTA
Middle Name:DONIELLE
Last Name:GRIFFITH
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 1:211 ARROW HEAD DR
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-5507
Mailing Address - Country:US
Mailing Address - Phone:318-441-5900
Mailing Address - Fax:318-441-5980
Practice Address - Street 1:5505 SHREVEPORT HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-3533
Practice Address - Country:US
Practice Address - Phone:318-441-5900
Practice Address - Fax:318-441-5980
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2025-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAOBHPSS896175T00000X
LACIT-6007101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist