Provider Demographics
NPI:1053955625
Name:GRIFFITH, ANDREW RAY
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:RAY
Last Name:GRIFFITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 LINCOLNWAY E
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-3501
Mailing Address - Country:US
Mailing Address - Phone:574-252-7233
Mailing Address - Fax:844-361-2090
Practice Address - Street 1:3006 LINCOLNWAY E
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-3501
Practice Address - Country:US
Practice Address - Phone:574-252-7233
Practice Address - Fax:844-361-2090
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)