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General NPI Number Information
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NPI Number | 1407507478
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Entity Type | Individual
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Provider Name | KEVON JAMAL PURDIE MA,MSW, LPC
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Gender | Male
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Dates
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Enumeration Date | 01/12/2022
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 601 CHILDRENS LN
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City | NORFOLK
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State | VA
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Zip | 23507-1971
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Country | US
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Telephone | 757-668-7933
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Fax |
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Provider Business Mailing Address
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Address Line | 500 E PLUME ST APT 204
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City | NORFOLK
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State | VA
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Zip | 23510-2310
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Country | US
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Telephone | 757-535-8682
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701013519
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License Number State | VA
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