Provider Demographics
NPI:1457405557
Name:PURNELL, DENISE RENEE (EDD, LPC, LPCMH)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:RENEE
Last Name:PURNELL
Suffix:
Gender:F
Credentials:EDD, LPC, LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 KIRKWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:ELSMERE
Mailing Address - State:DE
Mailing Address - Zip Code:19805-2121
Mailing Address - Country:US
Mailing Address - Phone:302-383-3789
Mailing Address - Fax:302-998-1084
Practice Address - Street 1:1234 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:ELSMERE
Practice Address - State:DE
Practice Address - Zip Code:19805-5035
Practice Address - Country:US
Practice Address - Phone:302-998-1084
Practice Address - Fax:302-998-1084
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC0000671101YM0800X
PAPC003625101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000024626Medicaid