Provider Demographics
NPI:1205207206
Name:PINNIX, ROGER (MCAP)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:PINNIX
Suffix:
Gender:M
Credentials:MCAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5693 TRAVELERS WAY
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-4058
Mailing Address - Country:US
Mailing Address - Phone:772-480-3358
Mailing Address - Fax:
Practice Address - Street 1:202 NW 5TH AVE
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-4140
Practice Address - Country:US
Practice Address - Phone:863-467-2477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-010631-2015101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)