Provider Demographics
NPI:1104481027
Name:DEESE, PURLIE (LCAS)
Entity type:Individual
Prefix:
First Name:PURLIE
Middle Name:
Last Name:DEESE
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:PURLIE
Other - Middle Name:
Other - Last Name:DIAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1023 FAIRFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-6607
Mailing Address - Country:US
Mailing Address - Phone:910-550-3803
Mailing Address - Fax:910-550-3803
Practice Address - Street 1:803 STAMPER RD STE G
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4193
Practice Address - Country:US
Practice Address - Phone:910-223-7114
Practice Address - Fax:910-223-7114
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)