Provider Demographics
NPI:1497219232
Name:TREE OF LIFE FOR HEALING AND WELLNESS
Entity Type:Organization
Organization Name:TREE OF LIFE FOR HEALING AND WELLNESS
Other - Org Name:TREE OF LIFE HEALING AND WELLNESS, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:VONDA
Authorized Official - Middle Name:DIONNE
Authorized Official - Last Name:JONES-HUDSON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MDIV
Authorized Official - Phone:772-918-3166
Mailing Address - Street 1:1623 US HIGHWAY #1
Mailing Address - Street 2:SUITE A-6
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3879
Mailing Address - Country:US
Mailing Address - Phone:772-918-3166
Mailing Address - Fax:772-918-3411
Practice Address - Street 1:1623 US HIGHWAY #1
Practice Address - Street 2:SUITE A-6
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3879
Practice Address - Country:US
Practice Address - Phone:772-918-3166
Practice Address - Fax:772-918-3411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-25
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty