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Organization
NEW PROVENANCE COUNSELING CENTER, LLC
Active
Organization
NEW PROVENANCE COUNSELING CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE WORTHAM LCSW (OWNER)
(860) 845-1503
Entity
Organization
Contact information
Practice address
171 MARKET SQ STE 206A, NEWINGTON, CT 06111-2930
(860) 845-1503
(860) 370-4543
Mailing address
22 SAINT JAMES ST APT G, MANCHESTER, CT 06040-5957
(959) 222-8548
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
01/04/2021
Last updated
02/04/2025
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