Provider Demographics
NPI:1366805012
Name:GRIFFIN, GALE YVETTE (LISW)
Entity type:Individual
Prefix:MRS
First Name:GALE
Middle Name:YVETTE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 NOCTURNE RD E
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2017
Mailing Address - Country:US
Mailing Address - Phone:614-863-2672
Mailing Address - Fax:
Practice Address - Street 1:1215 NOCTURNE RD E
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2017
Practice Address - Country:US
Practice Address - Phone:614-877-2441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-31
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.1502418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health