Provider Demographics
NPI:1356983803
Name:ELLIS-MURRAY, DAWN A (LICSW-PIP, S)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:A
Last Name:ELLIS-MURRAY
Suffix:
Gender:F
Credentials:LICSW-PIP, S
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 230354
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36123-0354
Mailing Address - Country:US
Mailing Address - Phone:334-313-2767
Mailing Address - Fax:
Practice Address - Street 1:522 LEGENDS DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-6586
Practice Address - Country:US
Practice Address - Phone:334-313-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4249C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical