Provider Demographics
NPI:1548433303
Name:CLINICAL INTERVENTION SPECIALISTS, LLC
Entity type:Organization
Organization Name:CLINICAL INTERVENTION SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LOUTINA
Authorized Official - Middle Name:RENA
Authorized Official - Last Name:MURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:404-514-3292
Mailing Address - Street 1:6859 SLATE STONE WAY SE
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5469
Mailing Address - Country:US
Mailing Address - Phone:770-745-3556
Mailing Address - Fax:770-745-6903
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:678-422-0723
Practice Address - Fax:678-802-1970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW002771251S00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty