Provider Demographics
NPI:1598777070
Name:PURVIS, CARLA JANINE (MSW LCSW)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:JANINE
Last Name:PURVIS
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9209 ALLISON DR
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-5428
Mailing Address - Country:US
Mailing Address - Phone:812-200-8177
Mailing Address - Fax:812-422-7558
Practice Address - Street 1:4770 COVERT AVE STE 216D
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-5663
Practice Address - Country:US
Practice Address - Phone:812-200-8177
Practice Address - Fax:812-602-0082
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004666A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000392381OtherANTHEM
IN839090RRROtherMEDICARE
IN100240880Medicaid
IN11551064OtherCAQH