Provider Demographics
NPI:1659484764
Name:BALL, BRAD L (LPC)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:L
Last Name:BALL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1116
Mailing Address - Country:US
Mailing Address - Phone:304-645-7503
Mailing Address - Fax:304-645-7582
Practice Address - Street 1:333 N JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-1116
Practice Address - Country:US
Practice Address - Phone:304-645-7503
Practice Address - Fax:304-645-7582
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV81230101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)