MEDICARE: STACI PONDER

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1881542314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACI PONDER

Provider Business Mailing Address
First Line	:	PO BOX 782
Second Line	:
City	:	SAINT ALBANS
State	:	WV
Zip	:	25177-0782
Country	:	US
Telephone Number	:	681-205-8661
Fax Number	:

Provider Business Practice Location Address
First Line	:	208 DELAWARE AVE
Second Line	:
City	:	CHARLESTON
State	:	WV
Zip	:	25302-2004
Country	:	US
Telephone Number	:	681-205-8661
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2026
Last Update Date	:	03/19/2026

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Directions to “ STACI PONDER ” Practice Location

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