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1871072405
KENNETH VANCE
JACKSON, MS
NPI
1871072405
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2018-08-14
Last Update Date
2018-08-14
Business Address
KENNETH VANCE PCAT
3450 HIGHWAY 80 W
JACKSON, MS 39209-7201
Phone number: 601-321-2400
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Mailing Address
KENNETH VANCE PCAT
3450 HIGHWAY 80 W
JACKSON, MS 39209-7201
Phone number: 601-321-2400
Copy
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