Provider Demographics
NPI:1467826156
Name:PINCKNEY, MARYREBECCA MILLER (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:MARYREBECCA
Middle Name:MILLER
Last Name:PINCKNEY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:REBECCA
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:30537 POTOMAC WAY
Mailing Address - Street 2:SUITE 101/102
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622-3179
Mailing Address - Country:US
Mailing Address - Phone:240-587-7087
Mailing Address - Fax:
Practice Address - Street 1:30537 POTOMAC WAY
Practice Address - Street 2:SUITE 101/102
Practice Address - City:CHARLOTTE HALL
Practice Address - State:MD
Practice Address - Zip Code:20622-3179
Practice Address - Country:US
Practice Address - Phone:240-587-7087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical