Provider Demographics
NPI:1164279436
Name:PINKETT, ROMIE JEFFREY (LPC)
Entity type:Individual
Prefix:MR
First Name:ROMIE
Middle Name:JEFFREY
Last Name:PINKETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 W GRAND
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48203-3645
Mailing Address - Country:US
Mailing Address - Phone:313-330-8535
Mailing Address - Fax:
Practice Address - Street 1:138 W GRAND
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:MI
Practice Address - Zip Code:48203-3645
Practice Address - Country:US
Practice Address - Phone:313-330-8535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401223771101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health