Individual
LYDIA CARISSA PONGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLPC
Contact information
Practice address
830 PLEASANT ST, SAINT JOSEPH, MI 49085-1102
(269) 982-3832
Mailing address
4384 LAUREL DR, SAINT JOSEPH, MI 49085-9311
(269) 982-3832
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6401016718
MI
Other
Enumeration date
07/13/2018
Last updated
07/13/2018
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