Individual
MARIAH CHEYENNE PROVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5231 PENN AVE FL 1, PITTSBURGH, PA 15224-1768
(412) 204-9100
Mailing address
5231 PENN AVE FL 1, PITTSBURGH, PA 15224-1768
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
08/27/2018
Last updated
08/27/2018
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