Basic Information
| Provider Information | |||||||||
| NPI: | 1962950659 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PONCE | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8233 E STOCKTON BLVD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958288203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166793925 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8233 E STOCKTON BLVD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958288203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166793925 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2016 | ||||||||
| LastUpdateDate: | 09/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.