Provider Demographics
NPI:1386805463
Name:SUSAN A. PONTON THERAPIST INC
Entity type:Organization
Organization Name:SUSAN A. PONTON THERAPIST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PONTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-447-7447
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-0809
Mailing Address - Country:US
Mailing Address - Phone:434-447-7447
Mailing Address - Fax:434-447-3057
Practice Address - Street 1:501 N MECKLENBURG AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2024
Practice Address - Country:US
Practice Address - Phone:434-447-7447
Practice Address - Fax:434-447-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003560251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010030692Medicaid