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Zandral Kewan Green
Mental Health Counselor in Vicksburg, Mississippi
NPI 1124643069

Zandral Kewan Green is a Mental Health Counselor based in Vicksburg, MS and is specialized in Mental Health. Zandral Kewan Green practices in Vicksburg, MS. The NPI Number for Zandral Kewan Green is 1124643069 and holds a License No. (Mississippi).

The current practice location address for Zandral Kewan Green is 3442 Wisconsin Ave, Vicksburg, MS and can be reached out via phone at 601-634-0181.

Location: 3442 Wisconsin Ave, Vicksburg, MS, 39180-5858
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1124643069
Provider Name
Zandral Kewan Green
Credential
Provider Entity Type
Individual
Gender
Female
Address
3442 Wisconsin Ave, Vicksburg, MS, 39180-5858
Phone Number
601-634-0181
Fax Number
Provider Enumeration Date
06/16/2020
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00018215 05 MS
institution
Provider Business Practice Location Address Details
Address
3442 Wisconsin Ave
City
Vicksburg
State
Mississippi
Zip
39180-5331
Phone Number
601-634-0181
Fax Number
person
Provider Business Mailing Address Details
Address
3442 Wisconsin Ave
City
Vicksburg
State
Mississippi
Zip
39180-5331
Phone Number
601-634-0181
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
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Definition
Definition to come...
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