Individual
CARISSA PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMHC-P
Contact information
Practice address
8 BROAD ST, PLATTSBURGH, NY 12901-3420
(518) 825-1555
(518) 825-1550
Mailing address
8 BROAD ST, PLATTSBURGH, NY 12901-3420
(518) 825-1555
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
013715
NY
Other
Enumeration date
10/19/2021
Last updated
01/24/2024
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