Provider Demographics
NPI:1255127262
Name:THE PINE CENTER, PLLC
Entity type:Organization
Organization Name:THE PINE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KACI
Authorized Official - Middle Name:A
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHCA, MA
Authorized Official - Phone:765-343-6166
Mailing Address - Street 1:4915 PRESTWICK LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-2253
Mailing Address - Country:US
Mailing Address - Phone:812-345-3973
Mailing Address - Fax:812-345-3973
Practice Address - Street 1:6302 FAIRVIEW RD STE 310
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3273
Practice Address - Country:US
Practice Address - Phone:765-343-6166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-16
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)