Individual
KENNETH VANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PCAT
Contact information
Practice address
3450 HIGHWAY 80 W, JACKSON, MS 39209-7201
(601) 321-2400
(601) 985-5174
Mailing address
3450 HIGHWAY 80 W, JACKSON, MS 39209-7201
(601) 321-2400
(601) 985-5174
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00018209
—
MS
Enumeration date
08/14/2018
Last updated
08/14/2018
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