Provider Demographics
NPI:1407357395
Name:PINKERTON, JENNIFER (LCSW, LCDC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PINKERTON
Suffix:
Gender:F
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WILD OLIVE
Mailing Address - Street 2:
Mailing Address - City:LAGUNA VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2924
Mailing Address - Country:US
Mailing Address - Phone:956-592-0446
Mailing Address - Fax:
Practice Address - Street 1:1700 PADRE BLVD STE B
Practice Address - Street 2:
Practice Address - City:SOUTH PADRE ISLAND
Practice Address - State:TX
Practice Address - Zip Code:78597-6730
Practice Address - Country:US
Practice Address - Phone:956-592-0446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-26
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)