Provider Demographics
NPI:1922693977
Name:OLIVE TREE FAMILY COUNSELING, PLLC
Entity Type:Organization
Organization Name:OLIVE TREE FAMILY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:R.
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:MDIV/PC, LMFT
Authorized Official - Phone:252-514-1635
Mailing Address - Street 1:110 PLANTATION CREEK DR
Mailing Address - Street 2:
Mailing Address - City:VANCEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28586-9246
Mailing Address - Country:US
Mailing Address - Phone:252-514-1635
Mailing Address - Fax:
Practice Address - Street 1:110 PLANTATION CREEK DR
Practice Address - Street 2:
Practice Address - City:VANCEBORO
Practice Address - State:NC
Practice Address - Zip Code:28586-9246
Practice Address - Country:US
Practice Address - Phone:252-514-1635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105206Medicaid