Provider Demographics
NPI:1770504177
Name:BALLEW, JOHN R (LPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:BALLEW
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:BALLEW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:537 LINWOOD AVE NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4424
Mailing Address - Country:US
Mailing Address - Phone:404-659-5175
Mailing Address - Fax:
Practice Address - Street 1:537 LINWOOD AVE NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-4424
Practice Address - Country:US
Practice Address - Phone:404-659-5175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA577101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health