Organization
JUNIPER TREE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANDRE LAMONT POWELL SR. (CEO)
(757) 619-0658
Entity
Organization
Contact information
Practice address
348 BROAD ST, PORTSMOUTH, VA 23707
(757) 619-0658
Mailing address
1119 LAKEVIEW DR, PORTSMOUTH, VA 23701-3610
(757) 619-0658
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YM0800X
Mental Health Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
251E00000X
Home Health Agency
—
—
Other
Enumeration date
08/07/2017
Last updated
05/23/2023
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