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General NPI Number Information
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NPI Number | 1063740298
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE CHRISTIAN COUNSELING
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Dates
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Enumeration Date | 11/30/2009
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Last Update Date | 11/30/2009
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Provider Practice Location Address
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Address Line | 1512 FLORIDA AVE
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City | LYNCHBURG
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State | VA
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Zip | 24501-4112
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Country | US
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Telephone | 434-832-2100
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Fax | 434-832-2296
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Provider Business Mailing Address
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Address Line | PO BOX 42111
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City | FREDERICKSBURG
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State | VA
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Zip | 22404-2111
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Country | US
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Telephone | 540-834-7627
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. PHILICIA JEFFERSON
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Credential | PH.D.
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Telephone | 540-834-7627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 83102029
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License Number State | VA
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