Provider Demographics
NPI:1861002321
Name:PONDS, KRISTINE FAY
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:FAY
Last Name:PONDS
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 1:1327 N CONESTOGA ST
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-4202
Mailing Address - Country:US
Mailing Address - Phone:267-333-9110
Mailing Address - Fax:
Practice Address - Street 1:1327 N CONESTOGA ST
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19131-4202
Practice Address - Country:US
Practice Address - Phone:267-333-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-08
Last Update Date:2020-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health