Active NPI
Sotderia Griffin
- Professional Counselor
- Tallulah, LA
National Provider Identifier
1477903136
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 5886
- Practice address
- 124 Kimbrough Blvd BLDG Q
Tallulah, LA 71282-4307 - Phone
- (318) 574-4400
- Fax
- (318) 574-4407
- NPI assigned
- Jun 14, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 5886 | LA | Primary |
Addresses
Primary practice location
124 Kimbrough Blvd BLDG Q
Tallulah, LA 71282-4307
Mailing address
879 William Blvd Apt 21C
Ridgeland, MS 39157-1571
Phone (601) 310-6900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5886 | LA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Willpower LLC | Professional | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Professional Counselor
- Tallulah, LA
- NPI 1205318391
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465862400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465862400000",
"number": "1477903136",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "879 WILLIAM BLVD APT 21C",
"city": "RIDGELAND",
"state": "MS",
"postal_code": "391571571",
"telephone_number": "601-310-6900",
"fax_number": "318-574-4407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 KIMBROUGH BLVD BLDG Q",
"city": "TALLULAH",
"state": "LA",
"postal_code": "712824307",
"telephone_number": "318-574-4400",
"fax_number": "318-574-4407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIFFIN",
"first_name": "SOTDERIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-14",
"last_updated": "2016-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "LA",
"license": "5886",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tallulah, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.