Individual
KEERA QUANTAE LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3530 MANOR DR STE 5, VICKSBURG, MS 39180-5625
(601) 738-5260
Mailing address
860 E RIVER PL STE 100, JACKSON, MS 39202-3442
(769) 251-5590
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
05/28/2019
Last updated
05/28/2019
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