Provider Demographics
NPI:1457828105
Name:PONCIANO COUNSELING AND WELLNESS, LLC
Entity Type:Organization
Organization Name:PONCIANO COUNSELING AND WELLNESS, LLC
Other - Org Name:PONCIANO COUNSELING AND WELLNESS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:PONCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:LCMFT
Authorized Official - Phone:240-489-1108
Mailing Address - Street 1:19410 FISHER AVE
Mailing Address - Street 2:
Mailing Address - City:POOLESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20837-2256
Mailing Address - Country:US
Mailing Address - Phone:620-481-3135
Mailing Address - Fax:
Practice Address - Street 1:9029 SHADY GROVE CT
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1301
Practice Address - Country:US
Practice Address - Phone:240-489-1108
Practice Address - Fax:240-474-0068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty