Provider Demographics
NPI:1295039493
Name:BALLARD, MARY ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:BALLARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2898 MAHAN DRIVE -
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5462
Mailing Address - Country:US
Mailing Address - Phone:850-552-0691
Mailing Address - Fax:850-656-8969
Practice Address - Street 1:2898 MAHAN DRIVE -
Practice Address - Street 2:SUITE 5
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5462
Practice Address - Country:US
Practice Address - Phone:850-552-0691
Practice Address - Fax:850-656-8969
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-02
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW47671041C0700X
FLSW126961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical