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Individual

TERRI L PONDER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
1803 N JACKSON ST, TULLAHOMA, TN 37388-2201
(931) 461-1300
Mailing address
1803 N JACKSON ST, TULLAHOMA, TN 37388-2201
(931) 461-1300
(931) 461-1302

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
4623
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
LSW4623
MEDICAL LICENSE
TN
Enumeration date
02/07/2013
Last updated
03/08/2021
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