Healthcare Provider Details

I. General information

NPI: 1780994350
Provider Name (Legal Business Name): T. W. PONESSA AND ASSOCIATES COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 ASHBOURNE AVENUE
MANHEIM TOWNSHIP PA
17601
US

IV. Provider business mailing address

2141 OREGON PIKE
LANCASTER PA
17601
US

V. Phone/Fax

Practice location:
  • Phone: 717-560-7917
  • Fax: 717-560-6452
Mailing address:
  • Phone: 717-560-7917
  • Fax: 717-560-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number311720
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100775933
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: CATHERINE A. DEGUIRE
Title or Position: CEO
Credential: MS, JD, MBA
Phone: 717-560-7917