Individual
MR. ANDREW PROVENCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
2000 W MCINTOSH RD, GRIFFIN, GA 30223-6265
(678) 688-3133
(678) 688-3134
Mailing address
2000 W MCINTOSH RD, GRIFFIN, GA 30223-6265
(678) 688-3133
(678) 688-3134
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC003592
GA
Other
Enumeration date
01/18/2007
Last updated
07/08/2007
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