Provider Demographics
NPI:1265960173
Name:PURCELL, SHONNON (CRC, LPC-A,)
Entity type:Individual
Prefix:
First Name:SHONNON
Middle Name:
Last Name:PURCELL
Suffix:
Gender:M
Credentials:CRC, LPC-A,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 JOYCE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5227
Mailing Address - Country:US
Mailing Address - Phone:336-402-0148
Mailing Address - Fax:
Practice Address - Street 1:5500 ADAMS FARM LN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7063
Practice Address - Country:US
Practice Address - Phone:336-676-6064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool