Healthcare Provider Details

I. General information

NPI: 1457405557
Provider Name (Legal Business Name): DENISE RENEE PURNELL ED.D., LPC, LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 MAPLE AVE
ELSMERE DE
19805-5035
US

IV. Provider business mailing address

1301 KIRKWOOD HWY
ELSMERE DE
19805-2121
US

V. Phone/Fax

Practice location:
  • Phone: 302-998-1084
  • Fax: 302-998-1084
Mailing address:
  • Phone: 302-383-3789
  • Fax: 302-998-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC0000671
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC003625
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: