Provider Demographics
NPI:1598521148
Name:PINKSTON, CHASITY
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:
Last Name:PINKSTON
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 1:3828 SALEM RD # 147
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-4528
Mailing Address - Country:US
Mailing Address - Phone:678-925-3654
Mailing Address - Fax:
Practice Address - Street 1:2723 CARLETON GOLD RD
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-2808
Practice Address - Country:US
Practice Address - Phone:678-925-3654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician