Individual
CHARLOTTE D PONISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
115 N DIXIE DR STE 250, LAKE JACKSON, TX 77566-5906
(361) 649-1454
(979) 529-9853
Mailing address
PO BOX 491, LAKE JACKSON, TX 77566-0491
(361) 649-1454
(979) 529-9853
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
64264
TX
101YP2500X
Professional Counselor
64264
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
64264
LPC LICENSE
TX
Enumeration date
09/16/2011
Last updated
04/04/2022
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