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General NPI Number Information
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NPI Number | 1477819712
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE COUNSELING, PLLC
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Dates
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Enumeration Date | 04/10/2012
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Last Update Date | 08/26/2025
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Provider Practice Location Address
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Address Line | 5 OAK BRANCH DR STE H
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City | GREENSBORO
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State | NC
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Zip | 27407-2157
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Country | US
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Telephone | 336-288-9190
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Fax | 336-450-4318
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Provider Business Mailing Address
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Address Line | 5 OAK BRANCH DR STE H
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City | GREENSBORO
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State | NC
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Zip | 27407-2157
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Country | US
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Telephone | 336-288-9190
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Fax | 336-450-4318
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Authorized Official
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Title or Position | OWNER
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Name | SHANA GORDON WALTMAN
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Credential | MA
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Telephone | 336-288-9190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 7308
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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