Provider Demographics
NPI:1306105218
Name:VANTERPOOL, JUANTE
Entity type:Individual
Prefix:
First Name:JUANTE
Middle Name:
Last Name:VANTERPOOL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5434 BALDWIN PARK ST
Mailing Address - Street 2:104
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814-6942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:750 S ORANGE BLOSSOM TRL
Practice Address - Street 2:SUITE 220
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3118
Practice Address - Country:US
Practice Address - Phone:646-825-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-11
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004217-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health