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Samantha Star Ponce
Mental Health Counselor in San Gabriel, California
NPI 1073030011

Samantha Star Ponce is a Mental Health Counselor based in Los Angeles, CA and is specialized in Mental Health. Samantha Star Ponce practices in San Gabriel, CA. The NPI Number for Samantha Star Ponce is 1073030011 and holds a License No. (California).

The current practice location address for Samantha Star Ponce is 506 E Fairview Ave Apt A, San Gabriel, CA and can be reached out via phone at 323-485-7715.

Location: 506 E Fairview Ave Apt A, San Gabriel, CA, 90045-3653
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1073030011
Provider Name
Samantha Star Ponce
Credential
Provider Entity Type
Individual
Gender
Female
Address
506 E Fairview Ave Apt A, San Gabriel, CA, 90045-3653
Phone Number
323-485-7715
Fax Number
Provider Enumeration Date
08/29/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
506 E Fairview Ave Apt A
City
San Gabriel
State
California
Zip
91776-3039
Phone Number
323-485-7715
Fax Number
person
Provider Business Mailing Address Details
Address
506 E Fairview Ave Apt A
City
San Gabriel
State
California
Zip
91776-3039
Phone Number
323-485-7715
Fax Number
person
Provider's Taxonomy Details 1
Type
Behavioral Health & Social Service Providers
Classification
Counselor
Speciality
Mental Health
Taxonomy
101YM0800X
License No.
90672 (California)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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