Provider Demographics
NPI:1073606570
Name:BALL, JACQUELINE ROCHELLE
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:ROCHELLE
Last Name:BALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8550 FLORIN RD
Mailing Address - Street 2:#12
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-2600
Mailing Address - Country:US
Mailing Address - Phone:916-628-1671
Mailing Address - Fax:
Practice Address - Street 1:3353 BRADSHAW RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2607
Practice Address - Country:US
Practice Address - Phone:916-854-4564
Practice Address - Fax:916-857-1580
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)