Provider Demographics
NPI:1164677159
Name:CLINICAL INTERVENTION SPECIALISTS
Entity Type:Organization
Organization Name:CLINICAL INTERVENTION SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOUTINA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:MURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-422-0723
Mailing Address - Street 1:696 MOUNT ZION RD
Mailing Address - Street 2:SUITE 9-C
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1597
Mailing Address - Country:US
Mailing Address - Phone:678-802-1970
Mailing Address - Fax:
Practice Address - Street 1:6859 SLATE STONE WAY SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-5469
Practice Address - Country:US
Practice Address - Phone:770-745-3556
Practice Address - Fax:770-745-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health