Provider Demographics
NPI:1427542000
Name:BALLARD, RICHARD EARL JR (MSW, LPC AND LMFT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:EARL
Last Name:BALLARD
Suffix:JR
Gender:M
Credentials:MSW, LPC AND LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SITE OFFICE: CHARLES CARROLL MS 6130 LAMONT DRIVE
Mailing Address - Street 2:C/O MS. CLAUDIA B.-WALTER, FBCOG- CEO
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784
Mailing Address - Country:US
Mailing Address - Phone:301-458-0578
Mailing Address - Fax:
Practice Address - Street 1:SITE OFFICE: CHARLES CARROLL MS 6130 LAMONT DRIVE
Practice Address - Street 2:C/O MS. CLAUDIA B.-WALTER, FBCOG- CEO FOR SON RISE CC&I
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784
Practice Address - Country:US
Practice Address - Phone:301-458-0578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC618101Y00000X
DCLMFT000065106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor