Provider Demographics
NPI:1487078416
Name:ELLEN I KOSKI-PONTON
Entity type:Organization
Organization Name:ELLEN I KOSKI-PONTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:KOSKI-PONTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:704-282-5006
Mailing Address - Street 1:4610 NESBIT RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-7535
Mailing Address - Country:US
Mailing Address - Phone:704-282-5006
Mailing Address - Fax:704-635-8863
Practice Address - Street 1:202 N STEWART ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4767
Practice Address - Country:US
Practice Address - Phone:704-282-5006
Practice Address - Fax:704-635-8863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC553106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty