Provider Demographics
NPI:1689420853
Name:GRIFFITH, ANDREA ELAINE (RI MFT)
Entity type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:ELAINE
Last Name:GRIFFITH
Suffix:
Gender:F
Credentials:RI MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1274 THOMASVILLE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-3425
Mailing Address - Country:US
Mailing Address - Phone:941-883-8973
Mailing Address - Fax:
Practice Address - Street 1:2033 E EDGEWOOD DR STE 4
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3660
Practice Address - Country:US
Practice Address - Phone:863-345-2596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3948106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist