Healthcare Provider Details

I. General information

NPI: 1962181180
Provider Name (Legal Business Name): BREANNA NICOLE PURYEAR MSW, LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4024 STIRRUP CREEK DR
DURHAM NC
27703-9464
US

IV. Provider business mailing address

4024 STIRRUP CREEK DR
DURHAM NC
27703-9464
US

V. Phone/Fax

Practice location:
  • Phone: 919-908-9730
  • Fax:
Mailing address:
  • Phone: 919-238-9852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP019338
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: