Provider Demographics
NPI:1306993563
Name:PINKSTON, DONALD EUGENE JR (LCSW, CADC, QHEIC)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:EUGENE
Last Name:PINKSTON
Suffix:JR
Gender:M
Credentials:LCSW, CADC, QHEIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60160-3902
Mailing Address - Country:US
Mailing Address - Phone:708-681-0073
Mailing Address - Fax:708-681-3958
Practice Address - Street 1:1414 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-3902
Practice Address - Country:US
Practice Address - Phone:708-681-0073
Practice Address - Fax:708-681-3958
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490122861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical