Provider Demographics
NPI:1639892896
Name:POWERFUL PURPOSE PSYCHOLOGICAL & SUPPORT SERVICES
Entity type:Organization
Organization Name:POWERFUL PURPOSE PSYCHOLOGICAL & SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TRUTINA-MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOONAMORE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:919-500-3398
Mailing Address - Street 1:300 SOUTHTOWN CIR
Mailing Address - Street 2:
Mailing Address - City:ROLESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27571-9573
Mailing Address - Country:US
Mailing Address - Phone:562-394-8900
Mailing Address - Fax:
Practice Address - Street 1:1618 US 1 HWY
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-9219
Practice Address - Country:US
Practice Address - Phone:562-394-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty