Provider Demographics
NPI:1184640187
Name:BALL, BERNARD A (LMSW)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:A
Last Name:BALL
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66104
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-6104
Mailing Address - Country:US
Mailing Address - Phone:313-570-0974
Mailing Address - Fax:586-362-8803
Practice Address - Street 1:20500 EUREKA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6332
Practice Address - Country:US
Practice Address - Phone:734-285-8282
Practice Address - Fax:734-281-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010613771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical