Provider Demographics
NPI:1700583614
Name:PINKSTON, TASIA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TASIA
Middle Name:M
Last Name:PINKSTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 464117
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30042-4117
Mailing Address - Country:US
Mailing Address - Phone:470-665-9680
Mailing Address - Fax:
Practice Address - Street 1:1 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5401
Practice Address - Country:US
Practice Address - Phone:470-665-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5095103T00000X
GAPSY004071103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist