Provider Demographics
NPI:1588293112
Name:GRIFFIN, ANGELICA MARIE
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIE
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 1:12500 SHADOWGLEN TRACE 3204
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653
Mailing Address - Country:US
Mailing Address - Phone:210-371-9398
Mailing Address - Fax:
Practice Address - Street 1:12500 SHADOWGLEN TRACE 3204
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653
Practice Address - Country:US
Practice Address - Phone:210-371-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-06
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No175T00000XOther Service ProvidersPeer Specialist