Philicia Jefferson Wilson

LBN: Tree Of Life Christian Counseling Agency, Llc
Philicia Jefferson Wilson is an health care organization with primary practice located at 4936 Southpoint Pkwy , Fredericksburg VA 22407-2659. The organization recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as the primary health care specialty. Tree Of Life Christian Counseling Agency, Llc can be contacted via phone (540) 710-0520, or through Jefferson, Philicia via phone (540) 710-0520.

Contact Information

Primary practice address
4936 Southpoint Pkwy Fredericksburg VA 22407-2659
Phone: (540) 710-0520
Fax: (703) 490-3544
Website:
Map and Directions
Authorized official contact:
Name: Jefferson, Philicia PH.D
Phone: (540) 710-0520

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 831 Virginia

Profile Details

NPI number 1699705459
LBN Legal business name Tree Of Life Christian Counseling Agency, Llc
DBA Doing business as Philicia Jefferson Wilson
Authorized official Jefferson, Philicia PH.D
Entity Organization
Organization subpart 1 No
Enumeration date Jul 4th, 2006
Last updated Jun 19th, 2008 - about 16 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699705459 NPPES
Virginia Other 258225000 MENTAL HEALTH OUTPATIENT
Virginia Other 441462 MENTAL HEALTH OUTPATIENT
Virginia MEDICAID 010200113 MENTAL HEALTH OUTPATIENT
Virginia MEDICAID 010276128 MENTAL HEALTH OUTPATIENT
Virginia MEDICAID 005411041 MENTAL HEALTH OUTPATIENT

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