Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 103TH0100X | Health Service |
NPI | 1285974832 |
---|---|
Provider Name | Mrs. Susan Cecilia Griffin |
First Address | Detroit, MI 48215-3141 |
Second Address | Detroit, MI 48215-3141 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2013 |
Last Update Date | 24/04/2013 |