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1447613427
JENNIFER IRENE PROVOST
PLACERVILLE, CA
NPI
1447613427
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2016-03-29
Last Update Date
2016-03-29
Business Address
-- JENNIFER IRENE PROVOST
2844 COLOMA ST
PLACERVILLE, CA 95667-4406
Phone number: 530-626-9240
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Mailing Address
-- JENNIFER IRENE PROVOST
5725 MAIN AVE APT 22
ORANGEVALE, CA 95662-5446
Phone number: 916-204-4293
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