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General NPI Number Information
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NPI Number | 1497219232
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Entity Type | Organization
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Legal Business Name | TREE OF LIFE FOR HEALING AND WELLNESS
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 1623 US HIGHWAY #1 SUITE A-6
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City | SEBASTIAN
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State | FL
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Zip | 32958-3879
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Country | US
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Telephone | 772-918-3166
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Fax | 772-918-3411
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Provider Business Mailing Address
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Address Line | 1623 US HIGHWAY #1 SUITE A-6
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City | SEBASTIAN
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State | FL
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Zip | 32958-3879
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Country | US
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Telephone | 772-918-3166
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Fax | 772-918-3411
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST
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Name | VONDA DIONNE JONES-HUDSON
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Credential | PHD, MDIV.
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Telephone | 772-918-3166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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