Basic Information
| Provider Information | |||||||||
| NPI: | 1346676327 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRIFFIN | ||||||||
| FirstName: | VICKIE | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 129 NE 11TH STREET | ||||||||
| Address2: | |||||||||
| City: | OAK ISLAND | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28465 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9105120488 | ||||||||
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| Practice Location | |||||||||
| Address1: | 120 COASTAL HORIZONS DR | ||||||||
| Address2: | |||||||||
| City: | SHALLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284706094 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107544515 | ||||||||
| FaxNumber: | 9107547997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 10095 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.