Provider Demographics
NPI:1952844615
Name:PONCE, OLIVIA ESTELLE (MSW, CADC II)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:ESTELLE
Last Name:PONCE
Suffix:
Gender:F
Credentials:MSW, CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 STATE HWY 308
Mailing Address - Street 2:PO BOX 174
Mailing Address - City:NE KEYPORT
Mailing Address - State:WA
Mailing Address - Zip Code:98345-9997
Mailing Address - Country:US
Mailing Address - Phone:541-228-2852
Mailing Address - Fax:
Practice Address - Street 1:18490 SUQUAMISH WAY NE UNIT 107
Practice Address - Street 2:
Practice Address - City:SUQUAMISH
Practice Address - State:WA
Practice Address - Zip Code:98392-9533
Practice Address - Country:US
Practice Address - Phone:360-394-8558
Practice Address - Fax:360-598-1724
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22-02-20139101YA0400X
OR1041C0700X
OR16-08-26101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)