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Individual

MS. MICHELLE L PROVOST

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPC, CHT

Contact information

Practice address
6315 KIPS LN, ORANGEBURG, SC 29115-9788
(803) 347-8600
Mailing address
6315 KIPS LN, ORANGEBURG, SC 29115-9788
(803) 347-8600

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6216
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
6216
LICENSE NUMBER
SC
Enumeration date
10/31/2022
Last updated
10/31/2022
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