Healthcare Provider Details

I. General information

NPI: 1568372530
Provider Name (Legal Business Name): TREE OF LIFE CLT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1113 FORDHAM RD
CHARLOTTE NC
28208-6215
US

IV. Provider business mailing address

7547 TANGLEWOOD WAY
DENVER NC
28037-9207
US

V. Phone/Fax

Practice location:
  • Phone: 302-268-7813
  • Fax:
Mailing address:
  • Phone: 302-268-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DAYRIN DREW
Title or Position: FOUNDER
Credential:
Phone: 302-268-7813