Individual
LAURA JEAN PROVOST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3501 TAYLOR AVE, BALTIMORE, MD 21236-4406
(410) 444-5000
Mailing address
1618 CEDAR PARK RD, ANNAPOLIS, MD 21401-3209
(410) 262-9222
Taxonomy
Speciality
Code
Description
License number
State
225CX0006X
Orientation and Mobility Training Rehabilitation Counselor
Primary
23025
MD
Other
Enumeration date
08/18/2021
Last updated
08/18/2021
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