Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP1600X | Pastoral Counselor | 11290 |
NPI | 1073845145 |
---|---|
Provider Name | Peggy Sanderford Ponder |
First Address | Birmingham, AL 35222-4420 |
Second Address | Birmingham, AL 35233-3107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2010 |
Last Update Date | 10/02/2010 |