Individual
JAMILA EBONY PROVITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSW, BA, MSW
Contact information
Practice address
2671 YOUNGSTOWN RD SE, WARREN, OH 44484-4404
(330) 469-9743
(330) 286-0055
Mailing address
8261 MARKET ST, BOARDMAN, OH 44512-6254
(330) 286-0050
(330) 286-0055
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
S.1904129
OH
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
08/20/2018
Last updated
02/20/2020
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