Provider Demographics
NPI:1598966897
Name:PUREZA, CHARLOTTE YOUNG (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:YOUNG
Last Name:PUREZA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1543 COUNTRYCLUB RD.
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909
Mailing Address - Country:US
Mailing Address - Phone:252-331-5874
Mailing Address - Fax:
Practice Address - Street 1:1064 NORTHSIDE RD
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-8522
Practice Address - Country:US
Practice Address - Phone:252-337-6880
Practice Address - Fax:252-337-6890
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3443101YP2500X
NC27504101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool