Healthcare Provider Details

I. General information

NPI: 1205746336
Provider Name (Legal Business Name): LIVE WELL CHILD AND FAMILY THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E MARKET ST STE 2E
SMITHFIELD NC
27577-3980
US

IV. Provider business mailing address

101 E MARKET ST STE 2E
SMITHFIELD NC
27577-3980
US

V. Phone/Fax

Practice location:
  • Phone: 410-935-2479
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ALISSA PUCKETT
Title or Position: OWNER/CLINICIAN
Credential: MSW, LCSW
Phone: 919-213-1717