Provider Demographics
NPI:1760633200
Name:PONCE, TEHAUNA SOUIX
Entity Type:Individual
Prefix:
First Name:TEHAUNA
Middle Name:SOUIX
Last Name:PONCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 TENNESSEE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-4547
Mailing Address - Country:US
Mailing Address - Phone:707-647-1520
Mailing Address - Fax:707-647-1513
Practice Address - Street 1:1017 TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-4547
Practice Address - Country:US
Practice Address - Phone:707-647-1520
Practice Address - Fax:707-647-1513
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)