Provider Demographics
NPI:1710468665
Name:JUN-LIZZ LLC
Entity Type:Organization
Organization Name:JUN-LIZZ LLC
Other - Org Name:JUN-LIZZ SERENITY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:LESTER-LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:BS QMHP RPRS CSAC-A
Authorized Official - Phone:804-767-9723
Mailing Address - Street 1:4325 MYLAN RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2273
Mailing Address - Country:US
Mailing Address - Phone:804-767-9723
Mailing Address - Fax:
Practice Address - Street 1:4325 MYLAN RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2273
Practice Address - Country:US
Practice Address - Phone:804-767-9723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0711000285101YA0400X
VA0732000133101YM0800X, 171M00000X, 251B00000X, 251E00000X
VA0735000015175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Multi-Specialty