Organization
EMERGE AND EVOLVE THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUELYN PROVENZOLA LMSW (OWNER/PROVIDER)
(248) 385-2524
Entity
Organization
Contact information
Practice address
4902 CHILSON RD, HOWELL, MI 48843-9453
(248) 385-2524
Mailing address
4902 CHILSON RD, HOWELL, MI 48843-9453
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
04/18/2023
Last updated
04/18/2023
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