Provider Demographics
NPI:1952438582
Name:POND, VIRGINIA E (DBH, LCSW, CADC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:E
Last Name:POND
Suffix:
Gender:F
Credentials:DBH, LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1274
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619-6274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 PETER DANA POINT ROAD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:ME
Practice Address - Zip Code:04668-0466
Practice Address - Country:US
Practice Address - Phone:207-796-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC5229101Y00000X
MELC109321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME415180099Medicaid
ME415180099Medicaid
ME201826Medicare Oscar/Certification
MEMM4849OtherMEDICARE GROUP PTAN