Provider Demographics
NPI:1265062871
Name:PURE MIND COUNSELING GROUP
Entity type:Organization
Organization Name:PURE MIND COUNSELING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREAIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMIKA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASSENBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-998-3393
Mailing Address - Street 1:6741 CLARK RD
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-6419
Mailing Address - Country:US
Mailing Address - Phone:804-491-5300
Mailing Address - Fax:
Practice Address - Street 1:6741 CLARK RD
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-6419
Practice Address - Country:US
Practice Address - Phone:804-491-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health