Provider Demographics
NPI:1861038572
Name:MURRAY, MICHELLE (COUNSELOR)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MURRAY
Suffix:
Gender:F
Credentials:COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1163
Mailing Address - Street 2:
Mailing Address - City:CONLEY
Mailing Address - State:GA
Mailing Address - Zip Code:30288-7017
Mailing Address - Country:US
Mailing Address - Phone:678-362-9443
Mailing Address - Fax:
Practice Address - Street 1:151 LOCUST ST
Practice Address - Street 2:
Practice Address - City:AVONDALE ESTATES
Practice Address - State:GA
Practice Address - Zip Code:30002-1050
Practice Address - Country:US
Practice Address - Phone:678-362-9443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA07190811101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty