Provider Demographics
NPI:1063770600
Name:MURRAY, LORI DAWN (CSAC ICADC)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:DAWN
Last Name:MURRAY
Suffix:
Gender:F
Credentials:CSAC ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15-280 PUNI MAKAI LOOP S
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-8806
Mailing Address - Country:US
Mailing Address - Phone:808-854-1309
Mailing Address - Fax:
Practice Address - Street 1:118 KAMEHAMEHA AVE STE 4
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2813
Practice Address - Country:US
Practice Address - Phone:808-854-1309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2012-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
HI1707-12101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator