Provider Demographics
NPI:1043514722
Name:POND, TED L JR (LCSW, CSAC)
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:L
Last Name:POND
Suffix:JR
Gender:M
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2154
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96745-2154
Mailing Address - Country:US
Mailing Address - Phone:808-238-2932
Mailing Address - Fax:808-327-1809
Practice Address - Street 1:76-6225 KUAKINI HWY
Practice Address - Street 2:B-105
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3211
Practice Address - Country:US
Practice Address - Phone:808-238-2932
Practice Address - Fax:808-327-1809
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW 36801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical