Doctor Name: | MR. DAVID FITZGERALD PURVIS |
NPI Number: | 1134267115 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LADC-1 |
License Number: | |
Business Practice Address: | 55 Dimock St Roxbury, MA - 021191029 |
Business Phone Number: | 6174428800 |
Business Fax Number: | |
Mailing Address: | 33 Marshalls Corner Rd, BROCKTON |
State: | MA |
Postal Code: | 023014442 |
Phone Number: | 5085783108 |
Fax Number: | |
NPI Enumeration Date: | 02/02/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |