Provider Demographics
NPI:1093556474
Name:GRIFFIN, MARGO REA (SUDRC)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:REA
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 W 1ST ST APT 307
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-4045
Mailing Address - Country:US
Mailing Address - Phone:502-912-3671
Mailing Address - Fax:
Practice Address - Street 1:12781 JOSEPHINE ST
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92841-4622
Practice Address - Country:US
Practice Address - Phone:657-251-0503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-01
Last Update Date:2024-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18166101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)