Provider Demographics
NPI:1770806754
Name:PURCELL, SUSAN (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:PURCELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W MAIN ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:CARRBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27510-2088
Mailing Address - Country:US
Mailing Address - Phone:919-338-2865
Mailing Address - Fax:919-338-2865
Practice Address - Street 1:205 W MAIN ST
Practice Address - Street 2:SUITE 216
Practice Address - City:CARRBORO
Practice Address - State:NC
Practice Address - Zip Code:27510-2088
Practice Address - Country:US
Practice Address - Phone:919-338-2865
Practice Address - Fax:919-338-2865
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4336103TC2200X, 103T00000X, 103TF0000X, 103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy