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General NPI Number Information
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NPI Number | 1376141937
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 10/15/2020
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 3540 WHEELER RD STE 619
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City | AUGUSTA
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State | GA
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Zip | 30909-6534
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Country | US
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Telephone | 706-395-8606
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Fax | 706-395-8610
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Provider Business Mailing Address
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Address Line | 3540 WHEELER RD STE 619
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City | AUGUSTA
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State | GA
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Zip | 30909-6534
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Country | US
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Telephone | 706-395-8606
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Fax | 706-395-8610
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENNIFER LICHTENBERG ALVAREZ
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Credential | LMFT
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Telephone | 706-831-9440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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