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General NPI Number Information
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NPI Number | 1750663688
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Entity Type | Individual
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Provider Name | CHARLOTTE D PONISH LPC
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Gender | Female
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 04/04/2022
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Provider Practice Location Address
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Address Line | 115 N DIXIE DR STE 250
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City | LAKE JACKSON
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State | TX
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Zip | 77566-5906
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Country | US
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Telephone | 361-649-1454
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Fax | 979-529-9853
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Provider Business Mailing Address
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Address Line | PO BOX 491
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City | LAKE JACKSON
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State | TX
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Zip | 77566-0491
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Country | US
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Telephone | 361-649-1454
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Fax | 979-529-9853
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 64264
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 64264
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License Number State | TX
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