MR. Michael Joseph Provencher JR., LGPC

NPI #1811793813 in Glyndon, Maryland

Provider Information

NPI Number: 1811793813
Entity Type: Individual
Name: MR. Michael Joseph Provencher JR., LGPC
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor - Mental Health
Credential: LGPC
Enumeration Date: Feb 20, 2025
Last Updated: Feb 20, 2025

Practice Location

Address: 117 CENTRAL AVE
City: Glyndon
State: Maryland
ZIP Code: 21071-4208
Phone: (443) 244-1886

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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