Provider Demographics
NPI:1396577466
Name:PONDER, SHARI F (MA, MDIV)
Entity type:Individual
Prefix:
First Name:SHARI
Middle Name:F
Last Name:PONDER
Suffix:
Gender:F
Credentials:MA, MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ARGENTO DR APT 15304
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-5265
Mailing Address - Country:US
Mailing Address - Phone:404-914-8831
Mailing Address - Fax:
Practice Address - Street 1:1950 SPECTRUM CIR SE STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8469
Practice Address - Country:US
Practice Address - Phone:678-322-8887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-17
Last Update Date:2024-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YS0200X
101YP2500X, 101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral