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General NPI Number Information
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NPI Number | 1619753423
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Entity Type | Individual
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Provider Name | MARY VONNET ROSE-PINCKNEY LMFTA
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Gender | Female
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 348 CARLYLE ST
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City | LAKE CITY
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State | SC
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Zip | 29560-2322
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Country | US
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Telephone | 843-598-6170
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Fax |
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Provider Business Mailing Address
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Address Line | 348 CARLYLE ST
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City | LAKE CITY
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State | SC
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Zip | 29560-2322
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Country | US
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Telephone | 843-598-6170
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 8578
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License Number State | SC
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