Provider Demographics
NPI:1972072254
Name:PURYEAR, CLAIRE ANDERSON (LPCA, MED)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ANDERSON
Last Name:PURYEAR
Suffix:
Gender:F
Credentials:LPCA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:692 FAIRFIELD RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5306
Mailing Address - Country:US
Mailing Address - Phone:910-922-0548
Mailing Address - Fax:
Practice Address - Street 1:159 MAXWELL ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-5592
Practice Address - Country:US
Practice Address - Phone:910-922-0548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA1145101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC000031228122Medicaid