Individual
MR. MICHAEL JOSEPH PROVENCHER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LGPC
Contact information
Practice address
117 CENTRAL AVE, GLYNDON, MD 21071-4208
(443) 244-1886
Mailing address
PO BOX 3, 117 CENTRAL AVE., GLYNDON, MD 21071
(443) 244-1860
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LGP15969
MD
Other
Enumeration date
02/20/2025
Last updated
02/20/2025
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