Provider Demographics
NPI:1033971106
Name:PURCELL, KENYA LATRICE (LAPC)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:LATRICE
Last Name:PURCELL
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 MIDNIGHT RIDE CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-1102
Mailing Address - Country:US
Mailing Address - Phone:678-789-3939
Mailing Address - Fax:
Practice Address - Street 1:1725 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-9118
Practice Address - Country:US
Practice Address - Phone:678-789-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC009224101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health