MEDICARE: MRS. CHARLOTTE YOUNG PUREZA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3443	NC
2	101YS0200X	School Counselor	27504	NC

General Provider Information

NPI Number	:	1598966897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARLOTTE YOUNG PUREZA LPC

Provider Business Mailing Address
First Line	:	1543 COUNTRYCLUB RD.
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909
Country	:	US
Telephone Number	:	252-331-5874
Fax Number	:

Provider Business Practice Location Address
First Line	:	1064 NORTHSIDE RD
Second Line	:
City	:	ELIZABETH CITY
State	:	NC
Zip	:	27909-8522
Country	:	US
Telephone Number	:	252-337-6880
Fax Number	:	252-337-6890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	09/11/2025

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