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Organization
TREE OF LIFE CHRISTIAN COUNSELING AGENCY, LLC
Active
Organization
TREE OF LIFE CHRISTIAN COUNSELING AGENCY, LLC
Active
Other names
Philicia Jefferson Wilson
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PHILICIA JEFFERSON PH.D (DIRECTOR)
(540) 710-0520
Entity
Organization
Contact information
Practice address
4936 SOUTHPOINT PKWY, FREDERICKSBURG, VA 22407-2659
(540) 710-0520
(703) 490-3544
Mailing address
PO BOX 42111, FREDERICKSBURG, VA 22404-2111
(540) 710-0520
(703) 490-3544
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
831
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005411041
—
VA
05
—
010200113
—
VA
05
—
010276128
—
VA
01
—
258225000
MENTAL HEALTH OUTPATIENT
VA
01
—
441462
OUT-PATIENT MENTAL HEALTH
VA
Enumeration date
07/04/2006
Last updated
06/19/2008
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