1043514722 NPI number — MR. TED L. POND JR. LCSW, CSAC

Table of content: MR. TED L. POND JR. LCSW, CSAC (NPI 1043514722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043514722 NPI number — MR. TED L. POND JR. LCSW, CSAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POND
Provider First Name:
TED
Provider Middle Name:
L.
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
LCSW, CSAC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043514722
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2154
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAILUA KONA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96745-2154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-238-2932
Provider Business Mailing Address Fax Number:
808-327-1809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
76-6225 KUAKINI HWY
Provider Second Line Business Practice Location Address:
B-105
Provider Business Practice Location Address City Name:
KAILUA KONA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96740-3211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-238-2932
Provider Business Practice Location Address Fax Number:
808-327-1809
Provider Enumeration Date:
01/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW 3680 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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