Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 180-004817 | IL |
NPI | 1003488107 |
---|---|
Provider Name | Kimberly Pinkston |
First Address | Tinley Park, IL 60487-9344 |
Second Address | Tinley Park, IL 60487-9344 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2021 |
Last Update Date | 16/07/2021 |