Provider Demographics
NPI:1720619968
Name:BANYAN TREE COUNSELING PLLC
Entity Type:Organization
Organization Name:BANYAN TREE COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHANTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCMHC
Authorized Official - Phone:910-599-0218
Mailing Address - Street 1:1365 WESTGATE CENTER DR STE L1
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-3106
Mailing Address - Country:US
Mailing Address - Phone:336-448-4451
Mailing Address - Fax:
Practice Address - Street 1:3305 HEALY DR
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1406
Practice Address - Country:US
Practice Address - Phone:336-448-4451
Practice Address - Fax:336-450-1884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-27
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty