| NPI | 1205098951 |
|---|---|
| Former Name | GINA PROVENZANO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OH C.1000122) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2012-06-18 |