MEDICARE: ENJOLI PINO

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1346822079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ENJOLI PINO

Provider Business Mailing Address
First Line	:	5532 BLUE CEDAR DR
Second Line	:
City	:	SUGAR HILL
State	:	GA
Zip	:	30518-6918
Country	:	US
Telephone Number	:	770-572-3321
Fax Number	:

Provider Business Practice Location Address
First Line	:	5532 BLUE CEDAR DR
Second Line	:
City	:	SUGAR HILL
State	:	GA
Zip	:	30518-6918
Country	:	US
Telephone Number	:	770-572-3321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	04/22/2021

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Directions to “ ENJOLI PINO ” Practice Location

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