Provider Demographics
NPI:1265898035
Name:IFILL, KASCEY (CACII)
Entity type:Individual
Prefix:
First Name:KASCEY
Middle Name:
Last Name:IFILL
Suffix:
Gender:F
Credentials:CACII
Other - Prefix:
Other - First Name:KASCEY
Other - Middle Name:
Other - Last Name:IFILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:104 NORTH COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313
Mailing Address - Country:US
Mailing Address - Phone:912-877-3600
Mailing Address - Fax:
Practice Address - Street 1:104 N COMMERCE ST
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2720
Practice Address - Country:US
Practice Address - Phone:912-877-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA508502101YA0400X
GALPC01092101YP2500X
GA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional