MEDICARE: T.W. PONESSA AND ASSOCIATES COUNSELING SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063627651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	T.W. PONESSA AND ASSOCIATES COUNSELING SERVICES, INC.

Provider Business Mailing Address
First Line	:	410 N. PRINCE STREET
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-3010
Country	:	US
Telephone Number	:	717-560-7917
Fax Number	:	717-560-6452

Provider Business Practice Location Address
First Line	:	410 N. PRINCE STREET
Second Line	:
City	:	LANCASTER
State	:	PA
Zip	:	17603-3010
Country	:	US
Telephone Number	:	717-560-7917
Fax Number	:	717-560-6452

Authorized Official
Title or Position	:	CEO
Name	:	CATHERINE ANN DEGUIRE
Credential	:	MS, JD, MBA
Telephone Number	:	717-560-7917

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	08/15/2013

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