Provider Demographics
NPI:1710670435
Name:PINNEKE, SOPHIE
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:PINNEKE
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:QUEST PROVIDER SERVICES LLC
Mailing Address - Street 2:2329 E WT HARRIS BLVD
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5186
Mailing Address - Country:US
Mailing Address - Phone:704-529-9090
Mailing Address - Fax:704-529-9009
Practice Address - Street 1:QUEST PROVIDER SERVICES LLC
Practice Address - Street 2:2329 E WT HARRIS BLVD
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-5186
Practice Address - Country:US
Practice Address - Phone:704-529-9090
Practice Address - Fax:704-529-9009
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-23-65700103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst