Provider Demographics
NPI:1447053525
Name:MINNIFIELD, KATHLEEN JAMILA
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JAMILA
Last Name:MINNIFIELD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 DARNELL RD SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-3953
Mailing Address - Country:US
Mailing Address - Phone:828-556-0628
Mailing Address - Fax:
Practice Address - Street 1:1471 DARNELL RD SE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-3953
Practice Address - Country:US
Practice Address - Phone:828-556-0628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional