Healthcare Provider Details

I. General information

NPI: 1528928066
Provider Name (Legal Business Name): AMANDA SUYDAM PURVIS LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WHITEHEAD AVE NE
WILSON NC
27893-3713
US

IV. Provider business mailing address

115 WHITEHEAD AVE NE
WILSON NC
27893-3713
US

V. Phone/Fax

Practice location:
  • Phone: 910-691-3739
  • Fax:
Mailing address:
  • Phone: 910-691-3739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP023132
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: