Individual
CORNELIA AUTHORINE MINNIFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
360 FREEMONT RD, LONGS, SC 29568-8303
(405) 669-7170
Mailing address
360 FREEMONT RD, LONGS, SC 29568-8303
(405) 669-7170
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
11875
OK
Other
Enumeration date
05/16/2024
Last updated
05/16/2024
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