Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | PH4834 | MS |
NPI | 1003485798 |
---|---|
Provider Name | Jamaal Murriel |
First Address | Pearl, MS 39208-6293 |
Second Address | Jackson, MS 39216-5028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2021 |
Last Update Date | 18/06/2021 |