Provider Demographics
NPI:1437801172
Name:PONCE, NICOLE CATHLEEN (LPC-S, LCDC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:CATHLEEN
Last Name:PONCE
Suffix:
Gender:F
Credentials:LPC-S, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ELDRIDGE RD STE D
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4640
Mailing Address - Country:US
Mailing Address - Phone:832-723-3661
Mailing Address - Fax:
Practice Address - Street 1:120 ELDRIDGE RD STE D
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4640
Practice Address - Country:US
Practice Address - Phone:832-723-3661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70868101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty