Provider Demographics
NPI:1043311095
Name:BALL, SHELLENE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHELLENE
Middle Name:MARIE
Last Name:BALL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11023 JOE WARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:DE
Mailing Address - Zip Code:19956-4576
Mailing Address - Country:US
Mailing Address - Phone:302-280-6256
Mailing Address - Fax:302-280-6272
Practice Address - Street 1:11023 JOE WARRINGTON DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:DE
Practice Address - Zip Code:19956
Practice Address - Country:US
Practice Address - Phone:302-280-6256
Practice Address - Fax:302-280-6272
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0001007103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical