Provider Demographics
NPI:1497308274
Name:PURYEAR, JOHN WADE (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WADE
Last Name:PURYEAR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10202 DONEGAL PL
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-3753
Mailing Address - Country:US
Mailing Address - Phone:804-631-3255
Mailing Address - Fax:
Practice Address - Street 1:10202 DONEGAL PL
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-3753
Practice Address - Country:US
Practice Address - Phone:804-631-3255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-20
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
0701008483101Y00000X
VA0701008483101YP2500X, 102L00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst