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1063142768
TRACY PROVEAUX
COLUMBIA, SC
NPI
1063142768
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2022-06-15
Last Update Date
2022-06-15
Business Address
TRACY PROVEAUX
2711 COLONIAL DR
COLUMBIA, SC 29203-6818
Phone number: 803-726-9300
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Mailing Address
TRACY PROVEAUX
2711 COLONIAL DR
COLUMBIA, SC 29203-6818
Phone number: 803-726-9300
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