Provider Demographics
NPI:1982945622
Name:MURRELL SOCIAL SERVICES NETWORK
Entity Type:Organization
Organization Name:MURRELL SOCIAL SERVICES NETWORK
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:678-906-3011
Mailing Address - Street 1:6859 SLATE STONE WAY SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5469
Mailing Address - Country:US
Mailing Address - Phone:678-906-3011
Mailing Address - Fax:678-802-1970
Practice Address - Street 1:696 MOUNT ZION RD
Practice Address - Street 2:SUITE 9-C
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1597
Practice Address - Country:US
Practice Address - Phone:678-906-3011
Practice Address - Fax:678-802-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-05
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW002271251S00000X, 253J00000X
GACSW003257251S00000X
GACSW003448251S00000X
GALPC003980251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicaid