Provider Demographics
NPI:1376141937
Name:TREE OF LIFE PSYCHOTHERAPY, LLC
Entity type:Organization
Organization Name:TREE OF LIFE PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LICHTENBERG
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:706-831-9440
Mailing Address - Street 1:3540 WHEELER RD STE 619
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6534
Mailing Address - Country:US
Mailing Address - Phone:706-395-8606
Mailing Address - Fax:706-395-8610
Practice Address - Street 1:3540 WHEELER RD STE 619
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6534
Practice Address - Country:US
Practice Address - Phone:706-395-8606
Practice Address - Fax:706-395-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty