RICHARD RUSSELL PROVENCIAL

AURORA, CO
NPI1538790134
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: CO  ACC.0998145)
Enumeration Date2020-02-01
Last Update Date2024-11-06
Business Address
RICHARD RUSSELL PROVENCIAL CAS
2993 S PEORIA ST STE G5
AURORA, CO 80014-5705
Phone number: 720-249-8862
Mailing Address
RICHARD RUSSELL PROVENCIAL CAS
5360 S ELATI ST APT 6
LITTLETON, CO 80120-1527
Phone number: 720-249-8862
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