Provider Demographics
NPI:1346413101
Name:MURRELL, LOUTINA RENA
Entity Type:Individual
Prefix:
First Name:LOUTINA
Middle Name:RENA
Last Name:MURRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6859 SLATE STONE WAY SE
Mailing Address - Street 2:SUITE 3-C
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5469
Mailing Address - Country:US
Mailing Address - Phone:404-245-0659
Mailing Address - Fax:678-802-1970
Practice Address - Street 1:6859 SLATE STONE WAY SE
Practice Address - Street 2:SUITE 3-C
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-5469
Practice Address - Country:US
Practice Address - Phone:404-245-0659
Practice Address - Fax:678-802-1970
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW0027711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical