Provider Demographics
NPI:1083948756
Name:BALL, CHARLES (LCPC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BALL
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 CRESTMONT RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5811
Mailing Address - Country:US
Mailing Address - Phone:505-819-7678
Mailing Address - Fax:
Practice Address - Street 1:91 CRESTMONT RD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5811
Practice Address - Country:US
Practice Address - Phone:505-819-7678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2023-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC4970101YM0800X
NM0126121101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health