Provider Demographics
NPI:1699325225
Name:PINNOLA, CATHERINE ANNE AURORA (MS, CAGS, NCSP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANNE AURORA
Last Name:PINNOLA
Suffix:
Gender:F
Credentials:MS, CAGS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 ATALAYA PL
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-5175
Mailing Address - Country:US
Mailing Address - Phone:267-221-0535
Mailing Address - Fax:
Practice Address - Street 1:4012 ATALAYA PL
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-5175
Practice Address - Country:US
Practice Address - Phone:267-221-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC279470103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool