Provider Demographics
NPI:1558880500
Name:PINCKNEY, RAYNIECE K
Entity Type:Individual
Prefix:
First Name:RAYNIECE
Middle Name:K
Last Name:PINCKNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 ROSEBERRY LN APT 1356
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-2857
Mailing Address - Country:US
Mailing Address - Phone:843-452-6028
Mailing Address - Fax:
Practice Address - Street 1:2805 MILLWOOD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1298
Practice Address - Country:US
Practice Address - Phone:803-569-3101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2022-12-20
Deactivation Date:2020-02-21
Deactivation Code:
Reactivation Date:2022-11-04
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
SC6568101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC150808886687Medicaid
SC1508088888Medicaid