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General NPI Number Information
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NPI Number | 1922455195
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Entity Type | Individual
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Provider Name | LISA RENEE PURYEAR LPC
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Gender | Female
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Dates
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Enumeration Date | 05/18/2016
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 2212 DEVINE ST
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City | COLUMBIA
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State | SC
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Zip | 29205-2402
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Country | US
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Telephone | 803-573-4463
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Fax |
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Provider Business Mailing Address
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Address Line | 2417 CRAIG RD
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City | COLUMBIA
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State | SC
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Zip | 29204-2632
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Country | US
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Telephone | 803-403-7891
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 209
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 6824
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License Number State | SC
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