Provider Demographics
NPI:1679020093
Name:JOURNEY THROUGH LIFE, PLLC
Entity Type:Organization
Organization Name:JOURNEY THROUGH LIFE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PURNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPCS
Authorized Official - Phone:919-448-6105
Mailing Address - Street 1:3722 BENSON DR STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7389
Mailing Address - Country:US
Mailing Address - Phone:919-448-6105
Mailing Address - Fax:
Practice Address - Street 1:3722 BENSON DR STE 101
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7389
Practice Address - Country:US
Practice Address - Phone:919-448-6105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS5551251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008151Medicaid