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General NPI Number Information
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NPI Number | 1639030703
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Entity Type | Organization
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Legal Business Name | PURE TWENTY MIND & LIFE LLC
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Dates
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Enumeration Date | 11/19/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 125 MARGARETTA DRIVE
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City | MIDDLETOWN
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State | DE
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Zip | 19709
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Country | US
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Telephone | 267-304-9658
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Fax |
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Provider Business Mailing Address
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Address Line | 600 N BROAD STREET SUITE 5 #483
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City | MIDDLETOWN
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State | DE
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Zip | 19709
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LEAD CLINICIAN/OWNER
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Name | BRIANA SMITH
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Credential | LCSW
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Telephone | 267-304-9658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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