Provider Demographics
NPI:1215274329
Name:GRIFFITH, RANDALL (LCSW)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CARLSON PKWY N STE 401
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55447-4469
Mailing Address - Country:US
Mailing Address - Phone:855-482-6237
Mailing Address - Fax:763-717-8705
Practice Address - Street 1:8550 UNITED PLAZA BLVD
Practice Address - Street 2:SUITE 702
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2256
Practice Address - Country:US
Practice Address - Phone:855-482-6237
Practice Address - Fax:763-717-8705
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical