Provider Demographics
NPI:1518554575
Name:KINFE, RUTH D
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:D
Last Name:KINFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1384 SAXONY SQ
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-1218
Mailing Address - Country:US
Mailing Address - Phone:678-429-9688
Mailing Address - Fax:
Practice Address - Street 1:1384 SAXONY SQ
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-1218
Practice Address - Country:US
Practice Address - Phone:678-429-9688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-24
Last Update Date:2020-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-20-148657106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician