Healthcare Provider Details

I. General information

NPI: 1891168647
Provider Name (Legal Business Name): KELLY PINNICK M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 09/27/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N LEWIS ST STE A
LAGRANGE GA
30240-2752
US

IV. Provider business mailing address

205 N LEWIS ST STE A
LAGRANGE GA
30240-2752
US

V. Phone/Fax

Practice location:
  • Phone: 770-880-2538
  • Fax:
Mailing address:
  • Phone: 770-880-2538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: