Provider Demographics
NPI:1679098917
Name:POINDEXTER, AVA LEE (FWSP)
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:LEE
Last Name:POINDEXTER
Suffix:
Gender:F
Credentials:FWSP
Other - Prefix:MRS
Other - First Name:AVA
Other - Middle Name:LEE
Other - Last Name:WAGGONER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:GANS
Mailing Address - State:OK
Mailing Address - Zip Code:74936-0117
Mailing Address - Country:US
Mailing Address - Phone:918-315-2799
Mailing Address - Fax:
Practice Address - Street 1:1108 N WHEELER AVE
Practice Address - Street 2:
Practice Address - City:SALLISAW
Practice Address - State:OK
Practice Address - Zip Code:74955-2227
Practice Address - Country:US
Practice Address - Phone:918-775-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor