NPIMap

Organization Active NPI

Tree of Life Counseling, PLLC

  • Professional Counselor
  • Greensboro, NC
National Provider Identifier
1477819712
Registry record updated Aug 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
TREE OF LIFE COUNSELING, PLLC
Practice address
5 Oak Branch Dr Ste H
Greensboro, NC 27407-2157
Phone
(336) 288-9190
Fax
(336) 450-4318
NPI assigned
Apr 10, 2012
Last updated
Aug 26, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shana Gordon Waltman, MANPI 1184802266
Title
Owner
Phone
(336) 288-9190

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Counselor 101Y00000X NU
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Professional Counselor 101YP2500X 7308 NC
Professional Counselor 101YP2500X NU Primary
Clinical Social Worker 1041C0700X NU
Marriage & Family Therapist 106H00000X NU

Addresses

Primary practice location

5 Oak Branch Dr Ste H
Greensboro, NC 27407-2157

Mailing address

5 Oak Branch Dr Ste H
Greensboro, NC 27407-2157
Phone (336) 288-9190

Other practice location 1

2 DeWitt St
Jacksonville, NC 28540-5649
Phone (910) 333-1004

Other identifiers 1

IdentifierTypeStateIssuer
S7803OtherNCNORTH CAROLINA BOARD OF LICENSED CLINICAL MENTAL HEALTH COUNSELORS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130711000559 NC Part B Supplier - Clinic/Group Practice 4688814874 Receives reassigned benefits from 9 practitioners
Practice locations: Greensboro, NC

National Provider Directory

National Provider Directory

Locations

1821 Lendew St
Greensboro, NC 27408
Phone (336) 288-9190

1821 Lendew St
Ste A
Greensboro, NC 27408

5 Oak Branch Dr
Ste H
Greensboro, NC 27407
Phone (336) 288-9190

2 Dewitt St
Jacksonville, NC 28540
Phone (910) 333-1004

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756166400000",
    "number": "1477819712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 OAK BRANCH DR STE H",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274072157",
            "telephone_number": "336-288-9190",
            "fax_number": "336-450-4318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 OAK BRANCH DR STE H",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274072157",
            "telephone_number": "336-288-9190",
            "fax_number": "336-450-4318"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 DeWitt St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "NC",
            "postal_code": "285405649",
            "country_code": "US",
            "telephone_number": "910-333-1004",
            "fax_number": "336-450-4318",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TREE OF LIFE COUNSELING, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-10",
        "last_updated": "2025-08-26",
        "certification_date": "2025-08-26",
        "status": "A",
        "authorized_official_last_name": "WALTMAN",
        "authorized_official_first_name": "SHANA",
        "authorized_official_middle_name": "GORDON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "336-288-9190",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "7308",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH CAROLINA BOARD OF LICENSED CLINICAL MENTAL HEALTH COUNSELORS",
            "identifier": "S7803",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.