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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