Provider Demographics
NPI:1992397129
Name:PINNIX, NENA WATSON
Entity Type:Individual
Prefix:
First Name:NENA
Middle Name:WATSON
Last Name:PINNIX
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 1:165 TRELAWNEY PL
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-6807
Mailing Address - Country:US
Mailing Address - Phone:404-232-5765
Mailing Address - Fax:
Practice Address - Street 1:2300 W PARK PLACE BLVD
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-6713
Practice Address - Country:US
Practice Address - Phone:404-232-5765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional