Provider Demographics
NPI:1639892482
Name:BALLARD, LEE SUZANNE (TCADC)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:SUZANNE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 TWIN RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:BRONSTON
Mailing Address - State:KY
Mailing Address - Zip Code:42518-9605
Mailing Address - Country:US
Mailing Address - Phone:606-416-0247
Mailing Address - Fax:
Practice Address - Street 1:607 CLIFTY ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1765
Practice Address - Country:US
Practice Address - Phone:800-805-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY278725101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)