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General NPI Number Information
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NPI Number | 1265947550
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 12/07/2017
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 42273 CANARY GRASS SQ
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City | ALDIE
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State | VA
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Zip | 20105-5706
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Country | US
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Telephone | 703-798-0767
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Fax |
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Provider Business Mailing Address
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Address Line | 42273 CANARY GRASS SQ
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City | ALDIE
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State | VA
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Zip | 20105-5706
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Country | US
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Telephone | 703-798-0767
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MRS. ZAMIRA KEATING
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Credential | QMHP
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Telephone | 347-466-1587
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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 | 6633310
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License Number State | DE
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