Organization
PROVENZANO COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LIZA CRISTIN PROVENZANO LMHC (OWNER/COUNSELOR)
(904) 568-5826
Entity
Organization
Contact information
Practice address
13400 SUTTON PARK DR S STE 1504, JACKSONVILLE, FL 32224-0237
(904) 568-5826
Mailing address
912 COLLINSWOOD DR W, JACKSONVILLE, FL 32225-0861
(904) 568-5826
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
MH9038
FL
Other
Enumeration date
11/15/2017
Last updated
11/15/2017
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