DESIREE PROVENCIO

SANTA CLARITA, CA
NPI1205023447
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2007-10-02
Last Update Date2007-10-02
Business Address
-- DESIREE PROVENCIO
24625 ARCH ST
SANTA CLARITA, CA 91321-1111
Phone number: 661-254-6630
Mailing Address
-- DESIREE PROVENCIO
26460 SUMMIT CIR
SANTA CLARITA, CA 91350-2991
Phone number:
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