Provider Demographics
NPI:1205515780
Name:PINK, MARGARET TARA
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:TARA
Last Name:PINK
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 1:921 HILLSBERRY RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-2114
Mailing Address - Country:US
Mailing Address - Phone:256-283-0454
Mailing Address - Fax:
Practice Address - Street 1:600 CENTURY PARK S STE 200
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35226-3931
Practice Address - Country:US
Practice Address - Phone:205-999-5247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC03848101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health