Provider Demographics
NPI:1750047650
Name:MURRAY, SIMONE SHARLOTTE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SIMONE
Middle Name:SHARLOTTE
Last Name:MURRAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:SIMONE
Other - Middle Name:SHARLOTTE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2310 PRESCOTT PL
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-7603
Mailing Address - Country:US
Mailing Address - Phone:203-800-1522
Mailing Address - Fax:
Practice Address - Street 1:1941 PHINIZY RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-5173
Practice Address - Country:US
Practice Address - Phone:706-846-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
GA261QF0400X
GACSW0092171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)