Individual
MRS. SUSAN ALLEN PONTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
501 N MECKLENBURG AVE, SOUTH HILL, VA 23970-2024
(434) 447-7447
(434) 447-3057
Mailing address
PO BOX 809, SOUTH HILL, VA 23970-0809
(434) 447-7447
(434) 447-3057
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
0701003560
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010030692
—
VA
01
—
104658
ANTHEM PROVIDER NUMBER
VA
01
—
54-1977426
FEIN (SUB-S )
VA
01
—
86353M
SENTARA PROVIDER NUMBER
VA
Enumeration date
08/03/2006
Last updated
07/03/2008
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