Provider Demographics
NPI:1811276728
Name:WHITFIELD, KISHA HASSANNA (M ED)
Entity type:Individual
Prefix:MS
First Name:KISHA
Middle Name:HASSANNA
Last Name:WHITFIELD
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4916 LOCHERBY DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-4383
Mailing Address - Country:US
Mailing Address - Phone:404-553-6871
Mailing Address - Fax:678-818-4619
Practice Address - Street 1:619 MAIN ST
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-1142
Practice Address - Country:US
Practice Address - Phone:770-463-0202
Practice Address - Fax:678-818-4619
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional