Individual
KEANDRA MONSHELL FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3121 N OAK STREET EXT, VALDOSTA, GA 31602-1099
(800) 832-9419
(855) 859-1671
Mailing address
3121 N OAK STREET EXT, VALDOSTA, GA 31602-1099
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/19/2022
Last updated
08/19/2022
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