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General NPI Number Information
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NPI Number | 1265960173
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Entity Type | Individual
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Provider Name | SHONNON PURCELL CRC, LPC-A,
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Gender | Male
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Dates
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Enumeration Date | 05/23/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5500 ADAMS FARM LN
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City | GREENSBORO
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State | NC
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Zip | 27407-7063
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Country | US
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Telephone | 336-676-6064
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Fax |
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Provider Business Mailing Address
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Address Line | 1811 JOYCE ST
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City | GREENSBORO
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State | NC
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Zip | 27405-5227
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Country | US
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Telephone | 336-402-0148
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | NC
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