MEDICARE: PINNACLE ENTERPRISE BUSINESS SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1073108171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINNACLE ENTERPRISE BUSINESS SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	7150 CHESAPEAKE RD
Second Line	:	SUITE 201
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2396
Country	:	US
Telephone Number	:	301-459-1080
Fax Number	:

Provider Business Practice Location Address
First Line	:	7150 CHESAPEAKE RD
Second Line	:	SUITE 201
City	:	HYATTSVILLE
State	:	MD
Zip	:	20784-2396
Country	:	US
Telephone Number	:	301-459-1080
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MICHEAL DAVIS
Credential	:
Telephone Number	:	703-919-2721

Provider Enumeration Date	:	03/02/2021
Last Update Date	:	03/02/2021

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