Provider Demographics
NPI:1457479487
Name:BALLARD, PEARLINE (SOCIAL WORKER)
Entity Type:Individual
Prefix:
First Name:PEARLINE
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15711 MARK TWAIN
Mailing Address - Street 2:3646 MT ELLIOTT
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207
Mailing Address - Country:US
Mailing Address - Phone:313-273-3656
Mailing Address - Fax:313-921-1182
Practice Address - Street 1:3646 MT ELLIOTT
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207
Practice Address - Country:US
Practice Address - Phone:313-921-4700
Practice Address - Fax:313-921-2882
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68020856551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical