Healthcare Provider Details

I. General information

NPI: 1235063611
Provider Name (Legal Business Name): PURPLE CANOPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10205 US HIGHWAY 15 501 UNIT 26-270
SOUTHERN PINES NC
28387-5179
US

IV. Provider business mailing address

10205 US HIGHWAY 15 501 UNIT 26-270
SOUTHERN PINES NC
28387-5179
US

V. Phone/Fax

Practice location:
  • Phone: 910-660-1900
  • Fax: 855-895-5224
Mailing address:
  • Phone: 910-660-1900
  • Fax: 855-895-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateNULL
# 7
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DENISE DAUVAL
Title or Position: DIRECTOR
Credential:
Phone: 978-500-0771