Provider Demographics
NPI:1962976480
Name:GRIFFIN, KATHY D (LCPC)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:D
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:RESTED
Other - Middle Name:COUNSELING
Other - Last Name:SERVICES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15218 N BERWICK LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-9029
Mailing Address - Country:US
Mailing Address - Phone:301-704-5470
Mailing Address - Fax:
Practice Address - Street 1:15218 N BERWICK LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-9029
Practice Address - Country:US
Practice Address - Phone:301-704-5470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC10406101YM0800X
MD8625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health