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General NPI Number Information
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NPI Number | 1295389062
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Entity Type | Organization
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Legal Business Name | S. PURCELL COUNSELING PC
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 1348 WESTGATE CENTER DR STE 205-206
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City | WINSTON SALEM
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State | NC
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Zip | 27103-2984
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Country | US
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Telephone | 336-404-4352
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Fax | 336-450-1534
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Provider Business Mailing Address
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Address Line | 1348 WESTGATE CENTER DR STE 205-206
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City | WINSTON SALEM
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State | NC
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Zip | 27103-2984
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Country | US
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Telephone | 336-404-4352
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Fax | 336-450-1534
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. SHONNON LARDELL PURCELL
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Credential | MS,CRC,LPC,LCAS-A
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Telephone | 336-404-4352
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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 |
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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 |
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Taxonomy #3
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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 |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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