Healthcare Provider Details

I. General information

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

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

871 VENETIA BAY BLVD STE 310
VENICE FL
34285-8054
US

IV. Provider business mailing address

871 VENETIA BAY BLVD STE 310
VENICE FL
34285-8054
US

V. Phone/Fax

Practice location:
  • Phone: 941-346-6465
  • Fax:
Mailing address:
  • Phone: 941-346-6465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22518
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: