Provider Demographics
NPI:1831466945
Name:PINNER, VIVIAN LOUISE (M ED, LMHC, NCC)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:LOUISE
Last Name:PINNER
Suffix:
Gender:F
Credentials:M ED, LMHC, NCC
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 748519
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8519
Mailing Address - Country:US
Mailing Address - Phone:904-376-3800
Mailing Address - Fax:904-376-3998
Practice Address - Street 1:4844 DEER LAKE DR W STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-4406
Practice Address - Country:US
Practice Address - Phone:904-376-3800
Practice Address - Fax:904-390-7431
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 6828101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health