Organization
PROVIDENT CLINICAL COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RACHEL LUCKI LISW (DIRECTOR)
(567) 393-9693
Entity
Organization
Contact information
Practice address
232 N MARKET ST, GALION, OH 44833-1920
(567) 393-9693
Mailing address
232 N MARKET ST, GALION, OH 44833-1920
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
I1600187
OH
Other
Enumeration date
09/26/2016
Last updated
09/26/2016
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