ELIZABETH ROSE PROVOST

STOCKTON, CA
NPI1851182117
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor Addiction (Substance Use Disorder)
(Licence: CA  19037)
Enumeration Date2025-05-15
Last Update Date2025-05-15
Business Address
ELIZABETH ROSE PROVOST RADT
3120 E ANITA ST
STOCKTON, CA 95205-3905
Phone number: 209-415-0315
Mailing Address
ELIZABETH ROSE PROVOST RADT
3120 E ANITA ST
STOCKTON, CA 95205-3905
Phone number: 209-415-0315
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