1922371319 NPI number — HEALING TREE COUNSELING AND WELLNESS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922371319 NPI number — HEALING TREE COUNSELING AND WELLNESS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALING TREE COUNSELING AND WELLNESS, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922371319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1436
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORNELIUS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28031-1436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-941-9419
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
911 NORTHEAST DRIVE
Provider Second Line Business Practice Location Address:
301
Provider Business Practice Location Address City Name:
DAVIDSON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-941-9419
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FIRULLO
Authorized Official First Name:
LISA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
704-941-9419

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  4287 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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