Healthcare Provider Details

I. General information

NPI: 1376834507
Provider Name (Legal Business Name): CALVIN J. POUNCY DSW, EDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 2ND ST
SANTA MONICA CA
90401-1122
US

IV. Provider business mailing address

1328 2ND ST
SANTA MONICA CA
90401-1122
US

V. Phone/Fax

Practice location:
  • Phone: 310-394-6889
  • Fax:
Mailing address:
  • Phone: 310-394-6889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW126233
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number25-QMHP-R-3487
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: