Healthcare Provider Details

I. General information

NPI: 1598966897
Provider Name (Legal Business Name): CHARLOTTE YOUNG PUREZA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 NORTHSIDE RD
ELIZABETH CITY NC
27909-8522
US

IV. Provider business mailing address

1543 COUNTRYCLUB RD.
ELIZABETH CITY NC
27909
US

V. Phone/Fax

Practice location:
  • Phone: 252-337-6880
  • Fax: 252-337-6890
Mailing address:
  • Phone: 252-331-5874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3443
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number27504
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: