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General NPI Number Information
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NPI Number | 1205207206
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Entity Type | Individual
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Provider Name | ROGER PINNIX MCAP
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Gender | Male
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 202 NW 5TH AVE
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City | OKEECHOBEE
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State | FL
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Zip | 34972-4140
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Country | US
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Telephone | 863-467-2477
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Fax |
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Provider Business Mailing Address
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Address Line | 5693 TRAVELERS WAY
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City | FORT PIERCE
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State | FL
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Zip | 34982-4058
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Country | US
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Telephone | 772-480-3358
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ADC-010631-2015
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License Number State | FL
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