Healthcare Provider Details

I. General information

NPI: 1992343982
Provider Name (Legal Business Name): JUNIPER TREE COUNSELING SVCS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2019
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 SWAMP CREEK LN
MONCKS CORNER SC
29461-7474
US

IV. Provider business mailing address

243 SWAMP CREEK LN
MONCKS CORNER SC
29461-7474
US

V. Phone/Fax

Practice location:
  • Phone: 843-534-8468
  • Fax: 866-829-1906
Mailing address:
  • Phone: 843-534-8468
  • Fax: 866-829-1906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MYRA DOROTHEA PINCKNEY
Title or Position: OWNER
Credential: NP
Phone: 843-534-8468