Provider Demographics
NPI:1063798502
Name:PURCELL - WENNEMANN, TIMI LENEA (LPC)
Entity type:Individual
Prefix:
First Name:TIMI
Middle Name:LENEA
Last Name:PURCELL - WENNEMANN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TIMI
Other - Middle Name:
Other - Last Name:WENNEMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:285 S PERRY ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4840
Mailing Address - Country:US
Mailing Address - Phone:678-938-0859
Mailing Address - Fax:770-381-5909
Practice Address - Street 1:285 S PERRY ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4840
Practice Address - Country:US
Practice Address - Phone:678-938-0859
Practice Address - Fax:770-381-5909
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-28
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006421101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional