Provider Demographics
NPI:1760024368
Name:BALLARD, VICTORIA BROOKE
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:BROOKE
Last Name:BALLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26647 ANDREW DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4164
Mailing Address - Country:US
Mailing Address - Phone:703-964-7170
Mailing Address - Fax:
Practice Address - Street 1:43490 YUKON DR STE 104
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-7302
Practice Address - Country:US
Practice Address - Phone:703-936-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician