Individual
COREY ISAIAH PURNELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSAC SUPERVISEE
Contact information
Practice address
5105Q BACKLICK RD, ANNANDALE, VA 22003-6072
(571) 517-2430
Mailing address
10736 MAPLE ST, FAIRFAX, VA 22030-5122
(757) 358-8250
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0709025467
VA
Other
Enumeration date
05/15/2024
Last updated
05/15/2024
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