| Juniper Tree Llc | |
|
348 Broad St Portsmouth VA 23707 | |
| (757) 619-0658 | |
| Not Available |
| Full Name | Juniper Tree Llc |
|---|---|
| Speciality | Counselor |
| Location | 348 Broad St, Portsmouth, Virginia |
| Authorized Official Name and Position | Andre Lamont Powell (CEO) |
| Authorized Official Contact | 7576190658 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Juniper Tree Llc 1119 Lakeview Dr Portsmouth VA 23701-3610 Ph: (757) 619-0658 | Juniper Tree Llc 348 Broad St Portsmouth VA 23707 Ph: (757) 619-0658 |
| NPI Number | 1437674900 |
|---|---|
| Provider Enumeration Date | 08/07/2017 |
| Last Update Date | 05/23/2023 |
| Certification Date | 05/23/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437674900 | NPI | - | NPPES |
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