Provider Demographics
NPI:1093074205
Name:HOLYFIELD, KASEY S
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:S
Last Name:HOLYFIELD
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 1:1801 CANTERBURY DR STE C
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-0503
Mailing Address - Country:US
Mailing Address - Phone:229-427-0057
Mailing Address - Fax:215-258-8588
Practice Address - Street 1:1801 CANTERBURY DR STE C
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-0503
Practice Address - Country:US
Practice Address - Phone:229-244-2030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health