NPI Code Detail JSON Logo

1295389062 NPI number — S. PURCELL COUNSELING PC

NPI Number: 1295389062
Health Care Provider/Practitioner: S. PURCELL COUNSELING PC

Information about “1295389062” NPI (S. PURCELL COUNSELING PC) exists in 1295389062 in HTML format HTML  |  1295389062 in plain Text format TXT  |  1295389062 in PDF (Portable Document Format) PDF  |  1295389062 in an XML format XML  formats.

NPI Number : 1295389062 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1295389062",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "S. PURCELL COUNSELING PC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1348 WESTGATE CENTER DR STE 205-206",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WINSTON SALEM",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27103-2984",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "336-404-4352",
    "MailingAddressFaxNumber": "336-450-1534",
    "FirstLinePracticeLocationAddress": "1348 WESTGATE CENTER DR STE 205-206",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WINSTON SALEM",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27103-2984",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "336-404-4352",
    "PracticeLocationAddressFaxNumber": "336-450-1534",
    "EnumerationDate": "07/30/2019",
    "LastUpdateDate": "06/04/2021",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PURCELL",
    "AuthorizedOfficialFirstName": "SHONNON",
    "AuthorizedOfficialMiddleName": "LARDELL",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": "MR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MS,CRC,LPC,LCAS-A",
    "AuthorizedOfficialTelephoneNumber": "336-404-4352",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "251S00000X",
          "TaxonomyName": "Community/Behavioral Health Agency",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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