Provider Demographics
NPI:1134747256
Name:OLIVE TREE COUNSELING, LLC
Entity type:Organization
Organization Name:OLIVE TREE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:RACKLEY
Authorized Official - Last Name:PADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, NCC, EMDR
Authorized Official - Phone:434-770-4326
Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-0860
Mailing Address - Country:US
Mailing Address - Phone:434-770-4326
Mailing Address - Fax:
Practice Address - Street 1:1186 FAIRVIEW N
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-3384
Practice Address - Country:US
Practice Address - Phone:434-770-4326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty