Healthcare Provider Details

I. General information

NPI: 1992486880
Provider Name (Legal Business Name): LENA M PINKSTON LSW, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E CENTRAL AVE
DECATUR IL
62521-1050
US

IV. Provider business mailing address

420 E CENTRAL AVE
DECATUR IL
62521-1050
US

V. Phone/Fax

Practice location:
  • Phone: 217-330-5676
  • Fax: 217-330-9712
Mailing address:
  • Phone: 217-330-5676
  • Fax: 217-330-9712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number22346
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.110865
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: