Healthcare Provider Details

I. General information

NPI: 1932572104
Provider Name (Legal Business Name): DWAN PINCKNEY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 08/12/2023
Certification Date: 08/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 BAYCENTER RD
JACKSONVILLE FL
32256-7420
US

IV. Provider business mailing address

8540 BAYCENTER RD
JACKSONVILLE FL
32256-7420
US

V. Phone/Fax

Practice location:
  • Phone: 904-448-1933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: