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General NPI Number Information
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NPI Number | 1033971106
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Entity Type | Individual
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Provider Name | KENYA LATRICE PURCELL LAPC
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Gender | Female
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Dates
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Enumeration Date | 01/25/2024
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Last Update Date | 01/25/2024
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Provider Practice Location Address
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Address Line | 1725 PENNSYLVANIA AVE
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City | MCDONOUGH
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State | GA
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Zip | 30253-9118
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Country | US
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Telephone | 678-789-3939
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Fax |
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Provider Business Mailing Address
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Address Line | 1355 MIDNIGHT RIDE CT
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City | HAMPTON
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State | GA
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Zip | 30228-1102
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Country | US
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Telephone | 678-789-3939
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | APC009224
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License Number State | GA
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