Provider Demographics
NPI:1164924908
Name:PONDECA, SARA RAE (MA LPC)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:RAE
Last Name:PONDECA
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:RAE
Other - Last Name:FIRKUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SARA RAE
Mailing Address - Street 1:82 S STONE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85701-1713
Mailing Address - Country:US
Mailing Address - Phone:520-792-3293
Mailing Address - Fax:520-792-4336
Practice Address - Street 1:8050 E LAKESIDE PKWY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85730-1254
Practice Address - Country:US
Practice Address - Phone:520-584-5820
Practice Address - Fax:520-514-1514
Is Sole Proprietor?:No
Enumeration Date:2018-03-07
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17079101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional