Provider Demographics
NPI:1386181733
Name:PURNELL, LYLE (MSW/LMSW)
Entity Type:Individual
Prefix:MR
First Name:LYLE
Middle Name:
Last Name:PURNELL
Suffix:
Gender:M
Credentials:MSW/LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 EMANCIPATION DR BLDG 146
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23667-0001
Mailing Address - Country:US
Mailing Address - Phone:757-722-9961
Mailing Address - Fax:757-728-3392
Practice Address - Street 1:100 EMANCIPATION DR BLDG 146
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-0001
Practice Address - Country:US
Practice Address - Phone:757-722-9961
Practice Address - Fax:757-728-3392
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000009075282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital