Individual
ZANDRAL KEWAN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3442 WISCONSIN AVE, VICKSBURG, MS 39180-5331
(601) 634-0181
Mailing address
4222 COMMONS CIR, VICKSBURG, MS 39180-5858
(601) 702-9411
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018215
—
MS
Enumeration date
06/16/2020
Last updated
06/30/2020
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