Provider Demographics
NPI:1497389076
Name:BALL, STEPHEN JOSEPH (LCAS-A)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:BALL
Suffix:
Gender:M
Credentials:LCAS-A
Other - Prefix:MR
Other - First Name:STEPHEN
Other - Middle Name:JOSEPH
Other - Last Name:BALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:COUNSELOR
Mailing Address - Street 1:2706 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-3657
Mailing Address - Country:US
Mailing Address - Phone:336-272-9990
Mailing Address - Fax:336-842-6984
Practice Address - Street 1:1617 S HAWTHORNE RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4127
Practice Address - Country:US
Practice Address - Phone:336-842-6980
Practice Address - Fax:336-842-6984
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-262332084A0401X
NC26233101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine