Provider Demographics
NPI:1104315142
Name:GRIFFIN, LAMONA WILLIAMS
Entity type:Individual
Prefix:
First Name:LAMONA
Middle Name:WILLIAMS
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 1:6361 TALOKAS LN STE C140
Mailing Address - Street 2:PMB 113
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909
Mailing Address - Country:US
Mailing Address - Phone:706-718-4008
Mailing Address - Fax:762-257-2484
Practice Address - Street 1:1661 13TH ST STE 104
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-3843
Practice Address - Country:US
Practice Address - Phone:706-718-4008
Practice Address - Fax:762-257-2484
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health