Provider Demographics
NPI:1922640598
Name:PINNER, TRAVIS (LPC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:PINNER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 JOPLIN LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6510
Mailing Address - Country:US
Mailing Address - Phone:757-714-3263
Mailing Address - Fax:
Practice Address - Street 1:6325 N CENTER DR BLDG 18
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4010
Practice Address - Country:US
Practice Address - Phone:757-227-3636
Practice Address - Fax:757-227-3642
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007973101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional