Healthcare Provider Details

I. General information

NPI: 1326517087
Provider Name (Legal Business Name): CHRISTINE ELIZABETH POND LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2018
Last Update Date: 02/16/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 SOUTHFORD RD
MIDDLEBURY CT
06762-3234
US

IV. Provider business mailing address

984 SOUTHFORD RD
MIDDLEBURY CT
06762-3234
US

V. Phone/Fax

Practice location:
  • Phone: 203-758-2400
  • Fax:
Mailing address:
  • Phone: 203-758-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3619
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: