Provider Demographics
NPI:1578911731
Name:BALLARD, CINDY (LCADC)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:BALLARD
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-9286
Mailing Address - Country:US
Mailing Address - Phone:502-510-9777
Mailing Address - Fax:
Practice Address - Street 1:1000 E JOHN ROWAN BLVD STE 107
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2060
Practice Address - Country:US
Practice Address - Phone:502-510-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-28
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY167186101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100432340Medicaid