Provider Demographics
NPI:1922371319
Name:HEALING TREE COUNSELING AND WELLNESS, PLLC
Entity Type:Organization
Organization Name:HEALING TREE COUNSELING AND WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FIRULLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:704-941-9419
Mailing Address - Street 1:PO BOX 1436
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-1436
Mailing Address - Country:US
Mailing Address - Phone:704-941-9419
Mailing Address - Fax:
Practice Address - Street 1:911 NORTHEAST DRIVE
Practice Address - Street 2:301
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036
Practice Address - Country:US
Practice Address - Phone:704-941-9419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4287101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherBCBS