Individual
KEWANDA VANDIVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
3643 WALTON WAY EXT, AUGUSTA, GA 30909-4507
(706) 364-1404
(706) 364-1419
Mailing address
3643 WALTON WAY EXT, AUGUSTA, GA 30909-4507
(706) 364-1404
(706) 364-1419
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
02/11/2013
Last updated
02/11/2013
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