Provider Demographics
NPI:1003488107
Name:PINKSTON, KIMBERLY (LCPC, CADC, BC-DMT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:PINKSTON
Suffix:
Gender:F
Credentials:LCPC, CADC, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8041 186TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-9344
Mailing Address - Country:US
Mailing Address - Phone:815-310-1582
Mailing Address - Fax:
Practice Address - Street 1:8041 186TH ST STE B
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-9344
Practice Address - Country:US
Practice Address - Phone:815-310-1582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-004817101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty