Provider Demographics
NPI:1720551120
Name:BALL, COLBY DEWAYNE (LPC)
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:DEWAYNE
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:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:CLINTWOOD
Mailing Address - State:VA
Mailing Address - Zip Code:24228-0309
Mailing Address - Country:US
Mailing Address - Phone:276-926-1680
Mailing Address - Fax:
Practice Address - Street 1:440 FOX TOWN RD
Practice Address - Street 2:
Practice Address - City:CLINTWOOD
Practice Address - State:VA
Practice Address - Zip Code:24228-5077
Practice Address - Country:US
Practice Address - Phone:276-926-1680
Practice Address - Fax:276-926-9179
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008048101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional