Basic Information
| Provider Information | |||||||||
| NPI: | 1699246603 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PONGRACE | ||||||||
| FirstName: | KATHIE | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3480 BUSKIRK AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | PLEASANT HILL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945234343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9258254700 | ||||||||
| FaxNumber: | 9258252610 | ||||||||
| Practice Location | |||||||||
| Address1: | 251 GEORGIA ST | ||||||||
| Address2: | |||||||||
| City: | VALLEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945905905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9254299000 | ||||||||
| FaxNumber: | 9257260143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2018 | ||||||||
| LastUpdateDate: | 12/17/2018 | ||||||||
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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 | 1041C0700X | LCSW69752 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.