Individual
RICHARD RUSSELL PROVENCIAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CAS
Contact information
Practice address
2993 S PEORIA ST STE G5, AURORA, CO 80014-5705
(720) 249-8862
Mailing address
5360 S ELATI ST APT 6, LITTLETON, CO 80120-1527
(720) 249-8862
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
ACC.0998145
CO
Other
Enumeration date
02/01/2020
Last updated
11/06/2024
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