Provider Demographics
NPI:1083899116
Name:PONCE OROZCO, NIDIA A (LCSW)
Entity type:Individual
Prefix:
First Name:NIDIA
Middle Name:A
Last Name:PONCE OROZCO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 HIDDEN OAKS RD
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-6220
Mailing Address - Country:US
Mailing Address - Phone:720-823-8340
Mailing Address - Fax:
Practice Address - Street 1:151 FM 3237 BLD 2 SUITE C
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-6220
Practice Address - Country:US
Practice Address - Phone:729-823-8340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1047081041C0700X
CO14991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical