Provider Demographics
NPI:1063576973
Name:PURNELL, BRIAN GREGORY (MED,LPC,ACS,EAS-C)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:GREGORY
Last Name:PURNELL
Suffix:
Gender:M
Credentials:MED,LPC,ACS,EAS-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3722 BENSON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7388
Mailing Address - Country:US
Mailing Address - Phone:919-454-4039
Mailing Address - Fax:240-266-0062
Practice Address - Street 1:3722 BENSON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7388
Practice Address - Country:US
Practice Address - Phone:919-454-4039
Practice Address - Fax:240-266-0062
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103406Medicaid