Provider Demographics
NPI:1194152165
Name:MURRAY, DIANA ALEXANDRIA (LISW-CP/S)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:ALEXANDRIA
Last Name:MURRAY
Suffix:
Gender:F
Credentials:LISW-CP/S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SPRINGTREE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-8614
Mailing Address - Country:US
Mailing Address - Phone:803-722-4975
Mailing Address - Fax:803-722-6018
Practice Address - Street 1:200 SPRINGTREE DR STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-8614
Practice Address - Country:US
Practice Address - Phone:803-722-4579
Practice Address - Fax:803-722-6018
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05631900104100000X
SC114641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJUBHC 4144007Medicaid
NJUBHC 4144007Medicaid