Provider Demographics
NPI:1124437124
Name:GRIFFITH, SHANA JEAN (LLMSW)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:JEAN
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 STODDARD RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MI
Mailing Address - Zip Code:48062-2505
Mailing Address - Country:US
Mailing Address - Phone:810-392-2167
Mailing Address - Fax:810-392-3530
Practice Address - Street 1:400 STODDARD RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:MI
Practice Address - Zip Code:48062-2505
Practice Address - Country:US
Practice Address - Phone:810-392-2167
Practice Address - Fax:810-392-3530
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010972361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1041C0700OtherTAXONOMY # LLMSW