Healthcare Provider Details

I. General information

NPI: 1457608564
Provider Name (Legal Business Name): LORI L. PINKERD LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5776 SAINT AUGUSTINE RD
JACKSONVILLE FL
32207-8030
US

IV. Provider business mailing address

5776 SAINT AUGUSTINE RD
JACKSONVILLE FL
32207-8030
US

V. Phone/Fax

Practice location:
  • Phone: 904-448-4700
  • Fax:
Mailing address:
  • Phone: 904-448-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH12340
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: