Provider Demographics
NPI:1043725047
Name:GRIFFIN, ANGEL MARIE
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:MARIE
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANGEL
Other - Middle Name:
Other - Last Name:MCKINLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 241224
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524
Mailing Address - Country:US
Mailing Address - Phone:907-302-9164
Mailing Address - Fax:907-677-7017
Practice Address - Street 1:3105 LAKESHORE DRIVE SUITE A-101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517
Practice Address - Country:US
Practice Address - Phone:907-302-9164
Practice Address - Fax:907-677-7017
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician