JENNIFER IRENE PROVOST

PLACERVILLE, CA
NPI1447613427
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2016-03-29
Last Update Date2016-03-29
Business Address
-- JENNIFER IRENE PROVOST
2844 COLOMA ST
PLACERVILLE, CA 95667-4406
Phone number: 530-626-9240
Mailing Address
-- JENNIFER IRENE PROVOST
5725 MAIN AVE APT 22
ORANGEVALE, CA 95662-5446
Phone number: 916-204-4293
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