Provider Demographics
NPI:1831494327
Name:MURRELL SOCIAL SERVICES NETWORK-NC
Entity Type:Organization
Organization Name:MURRELL SOCIAL SERVICES NETWORK-NC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LOUTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:404-245-0659
Mailing Address - Street 1:255 BELLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28526-9760
Mailing Address - Country:US
Mailing Address - Phone:404-245-0659
Mailing Address - Fax:678-802-1970
Practice Address - Street 1:255 BELLTOWN RD
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NC
Practice Address - Zip Code:28526-9760
Practice Address - Country:US
Practice Address - Phone:404-245-0659
Practice Address - Fax:678-802-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-14
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMSWXXXXXX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCXXXXXXXXXMedicaid