Provider Demographics
NPI:1477819712
Name:TREE OF LIFE COUNSELING, PLLC
Entity type:Organization
Organization Name:TREE OF LIFE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:WALTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:336-288-9190
Mailing Address - Street 1:5 OAK BRANCH DR STE H
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2157
Mailing Address - Country:US
Mailing Address - Phone:336-288-9190
Mailing Address - Fax:336-450-4318
Practice Address - Street 1:5 OAK BRANCH DR STE H
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-2157
Practice Address - Country:US
Practice Address - Phone:336-288-9190
Practice Address - Fax:336-450-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 1041C0700X, 106H00000X, 101YP2500X
NC7308101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCS7803OtherNORTH CAROLINA BOARD OF LICENSED CLINICAL MENTAL HEALTH COUNSELORS