Provider Demographics
NPI:1881370500
Name:PONGETTI, ALLISON JOY (LCMHCA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:JOY
Last Name:PONGETTI
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21024 CATAWBA AVE
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8585
Mailing Address - Country:US
Mailing Address - Phone:336-355-8084
Mailing Address - Fax:
Practice Address - Street 1:21024 CATAWBA AVE
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8585
Practice Address - Country:US
Practice Address - Phone:336-355-8084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18868101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health