Provider Demographics
NPI:1619753423
Name:ROSE-PINCKNEY, MARY VONNET (LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:VONNET
Last Name:ROSE-PINCKNEY
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 CARLYLE ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SC
Mailing Address - Zip Code:29560-2322
Mailing Address - Country:US
Mailing Address - Phone:843-598-6170
Mailing Address - Fax:
Practice Address - Street 1:348 CARLYLE ST
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SC
Practice Address - Zip Code:29560-2322
Practice Address - Country:US
Practice Address - Phone:843-598-6170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8578106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist