Provider Demographics
NPI:1396952768
Name:PINCKNEY, WM AMANZE MELVIN (MDIV, LICDC, SAP,)
Entity type:Individual
Prefix:MR
First Name:WM AMANZE
Middle Name:MELVIN
Last Name:PINCKNEY
Suffix:
Gender:M
Credentials:MDIV, LICDC, SAP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 N.20TH ST.
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203
Mailing Address - Country:US
Mailing Address - Phone:614-361-5100
Mailing Address - Fax:614-258-4496
Practice Address - Street 1:189 N 20TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1550
Practice Address - Country:US
Practice Address - Phone:614-361-5100
Practice Address - Fax:614-258-4496
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH944092101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)