Provider Demographics
NPI:1134959513
Name:BALLARD, LUCI LORRAINE JIAN HUI
Entity type:Individual
Prefix:
First Name:LUCI LORRAINE
Middle Name:JIAN HUI
Last Name:BALLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4519 LARK LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2819
Mailing Address - Country:US
Mailing Address - Phone:703-343-6191
Mailing Address - Fax:
Practice Address - Street 1:11720 BELTSVILLE DR
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3166
Practice Address - Country:US
Practice Address - Phone:202-790-8903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician