Individual
LINDSEY PROVENCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PCCI
Contact information
Practice address
707 14TH ST, MODESTO, CA 95354-2506
(209) 525-5080
Mailing address
707 14TH ST, MODESTO, CA 95354-2506
(209) 525-5080
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PCCI2758
CA
Other
Enumeration date
04/01/2017
Last updated
05/01/2017
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