Provider Demographics
NPI:1750985701
Name:THE TREE OF LIFE COUNSELING CENTER
Entity type:Organization
Organization Name:THE TREE OF LIFE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TATISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:FAUNTLEROY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:919-696-0072
Mailing Address - Street 1:2402 S MIAMI BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-4928
Mailing Address - Country:US
Mailing Address - Phone:919-696-0072
Mailing Address - Fax:
Practice Address - Street 1:2402 S MIAMI BLVD STE 108
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-4928
Practice Address - Country:US
Practice Address - Phone:919-696-0072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty