MEDICARE: PINES COMPNAY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1255019576
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINES COMPNAY LLC

Provider Business Mailing Address
First Line	:	4850 J M TURK RD
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-5112
Country	:	US
Telephone Number	:	770-572-3321
Fax Number	:

Provider Business Practice Location Address
First Line	:	4850 J M TURK RD
Second Line	:
City	:	FLOWERY BRANCH
State	:	GA
Zip	:	30542-5112
Country	:	US
Telephone Number	:	770-572-3321
Fax Number	:

Authorized Official
Title or Position	:	THERAPIST
Name	:	ENJOLI PINO
Credential	:	LPC
Telephone Number	:	770-572-3321

Provider Enumeration Date	:	07/06/2023
Last Update Date	:	07/06/2023

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Directions to “PINES COMPNAY LLC ” Practice Location

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