Provider Demographics
NPI:1609539105
Name:PINCKNEY, DOMINCIA S (RBT)
Entity type:Individual
Prefix:
First Name:DOMINCIA
Middle Name:S
Last Name:PINCKNEY
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 DELTONA BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-8017
Mailing Address - Country:US
Mailing Address - Phone:904-878-8683
Mailing Address - Fax:
Practice Address - Street 1:537 DELTONA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-8017
Practice Address - Country:US
Practice Address - Phone:904-878-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-21
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21187183106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician