Provider Demographics
NPI:1174260178
Name:MURCHISON, ORAVETTA R (CDCA)
Entity Type:Individual
Prefix:MS
First Name:ORAVETTA
Middle Name:R
Last Name:MURCHISON
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:MS
Other - First Name:ORAVETTA
Other - Middle Name:R
Other - Last Name:MURCHISONM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CDCA
Mailing Address - Street 1:1284 E 141ST ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2504
Mailing Address - Country:US
Mailing Address - Phone:216-303-2484
Mailing Address - Fax:
Practice Address - Street 1:1284 E 141ST ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-2504
Practice Address - Country:US
Practice Address - Phone:216-303-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.180158101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty