Healthcare Provider Details

I. General information

NPI: 1720619968
Provider Name (Legal Business Name): BANYAN TREE COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 HEALY DR
WINSTON SALEM NC
27103-1406
US

IV. Provider business mailing address

3303 HEALY DR STE B
WINSTON SALEM NC
27103-1569
US

V. Phone/Fax

Practice location:
  • Phone: 336-448-4451
  • Fax: 336-450-1884
Mailing address:
  • Phone: 336-448-4451
  • Fax: 336-450-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name: CHANTAL HAYES
Title or Position: OWNER/DIRECTOR
Credential: LCMHCS
Phone: 910-599-0218