Individual provider · Type 1 NPI

Corey Isaiah Purnell, CSAC SUPERVISEE

Addiction (Substance Use Disorder) Counselor · Annandale, VA

NPI number 1508615204 Active

Practice location

5105Q Backlick Rd
Annandale, VA 22003-6072

Call (571) 517-2430 Map

Mailing address

10736 Maple St
Fairfax, VA 22030-5122

Specialties and licenses

TaxonomyCodeLicense
Addiction (Substance Use Disorder) Counselor Primary 101YA0400X0709025467 (VA)

Addiction (Substance Use Disorder) Counselor: Definition to come...

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About NPI 1508615204

Corey Isaiah Purnell, CSAC SUPERVISEE's National Provider Identifier is 1508615204, issued on May 15, 2024. The primary taxonomy on file is Addiction (Substance Use Disorder) Counselor (101YA0400X), and the practice location is in Annandale, VA. The record was last updated on May 15, 2024.