Provider Demographics
NPI:1447560487
Name:PINKSTON-CAMP, MEGAN MICHELLE (MA, PHD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MICHELLE
Last Name:PINKSTON-CAMP
Suffix:
Gender:F
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 SUMMIT AVE
Mailing Address - Street 2:RISE BLDG., ROOM 157
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2853
Mailing Address - Country:US
Mailing Address - Phone:401-793-3582
Mailing Address - Fax:401-793-4534
Practice Address - Street 1:164 SUMMIT AVE
Practice Address - Street 2:RISE BLDG., ROOM 157
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2853
Practice Address - Country:US
Practice Address - Phone:401-793-3582
Practice Address - Fax:401-793-4534
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01208103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical