Provider Demographics
NPI:1730534017
Name:GRIFFIN, DENNIS (MA)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4428 STAFFORDSHIRE LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4238
Mailing Address - Country:US
Mailing Address - Phone:612-859-7108
Mailing Address - Fax:
Practice Address - Street 1:4428 STAFFORDSHIRE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4238
Practice Address - Country:US
Practice Address - Phone:612-859-7108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-25
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22784-R101YA0400X
MN106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist