1811055163 NPI number — MRS. MARIA CASTORIO BALLARD LCSW

Table of content: MRS. MARIA CASTORIO BALLARD LCSW (NPI 1811055163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811055163 NPI number — MRS. MARIA CASTORIO BALLARD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALLARD
Provider First Name:
MARIA
Provider Middle Name:
CASTORIO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

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:
1811055163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 JOHNSTON DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELMONT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-829-5416
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 SOUTH NEW HOPE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-884-2501
Provider Business Practice Location Address Fax Number:
704-884-2565
Provider Enumeration Date:
12/05/2006

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:  C004520 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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